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Elective stenting of symptomatic basilar artery stenosis
C R Gomez1, V K Misra, M W Liu
1Department of Neurology, University of Alabama at Birmingham, 35294, USA. crgomez@uab.edu
Insights
Elective stenting of the basilar artery is a safe and feasible procedure for patients with vertebrobasilar ischemia unresponsive to medical therapy. This endovascular technique significantly reduces stenosis, offering a promising alternative to traditional treatments.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous angioplasty of intracranial arteries carries risks like dissection and embolization.
- Stenting enhances angioplasty safety and durability across vascular beds.
- Intracranial stenting has been limited by the availability of suitable intracranial stents.
Purpose of the Study:
- To evaluate the feasibility and safety of elective basilar artery stenting in patients with vertebrobasilar ischemia.
- To assess the efficacy of stenting in reducing basilar artery stenosis.
- To determine the clinical outcomes following basilar artery stenting in a selected patient cohort.
Main Methods:
- Twelve patients with vertebrobasilar ischemia underwent elective basilar artery stenting.
- Patients included those with failed medical therapy or anticoagulation contraindications.
- Outcomes were assessed via neurological exams, quantitative angiography, and clinical follow-up.
Main Results:
- Stent placement was successful in all twelve patients.
- Mean stenosis decreased significantly from 71.4% to 10.3% (P<0.0001).
- No deaths, stent thromboses, perforations, ruptures, or myocardial infarctions occurred; most patients remained asymptomatic.
Conclusions:
- Elective basilar artery stenting is a feasible and low-risk procedure.
- The long-term stroke prevention and durability require further investigation.
Background And Purpose:
Percutaneous angioplasty of the intracranial arteries still carries the risk of dissection, with acute closure and embolization. Stenting has been shown to improve the safety and durability of angioplasty in every circulatory bed in which it has been applied. However, stenting of the intracranial arteries has been limited by the availability of stents that can be reliably deployed intracranially.
Methods:
Twelve patients underwent elective stenting of the basilar artery after episodes of vertebrobasilar ischemia. In all patients, either medical therapy had failed or the patient had a contraindication for long-term anticoagulation. Information from independent neurological examinations, quantitative angiography, and clinical follow-up was collected. Differences between pretreatment and posttreatment degree of stenoses were subjected to 1-way ANOVA for repeated measures.
Results:
There were 10 men and 2 women, all white, aged 40 to 82 years (mean age, 62.6 years). Stent placement was successful in all patients, leading to statistically significant changes in the degree of stenosis, from 71. 4% (range, 53% to 90%) to 10.3% (range, 0% to 36%) (P<0.0001). There were no deaths, stent thromboses, perforations, ruptures, or myocardial infarctions. Clinical follow-up was available for 0.5 to 16 months (mean, 5.9 months). One patient had nonspecific symptoms, and another had a transient ischemic attack. All other patients remained asymptomatic.
Conclusions:
Elective stenting of the basilar artery is feasible, with minimal risk to the patient. Its impact on long-term stroke prevention and its durability are unknown and will require further study.