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Angioplasty and stenting in the posterior cerebral circulation
M S Barakate1, K L Snook, T J Harrington
1Department of Surgery, University of Sydney, Royal North Shore Hospital, St. Leonards, NSW, Australia. msbarakate@hotmail.com
Purpose:
To report initial experience with intracranial vertebral artery (VA) and basilar artery (BA) percutaneous transluminal angioplasty (PTA) and stenting.
Methods:
Eleven patients (10 men; mean age 66 years, range 56-75) with intracranial 14 VA and 3 BA stenoses were managed from December 1997 through November 1999. All patients presented with vertebrobasilar ischemia (VBI) despite antiplatelet and anticoagulant therapy. Clinical presentations included visual disturbance (n = 8), dysarthria/dysphasia (n = 5), and vertigo (n = 5).
Results:
Five patients underwent PTA only of 7 lesions with a mean preprocedural stenosis of 80% (range 50%-90%) that was reduced to 54% (range 30%-70%) after dilation. Six patients received 9 stents, 2 for VA dissections, 3 for tandem lesions, and 1 for a BA lesion. There were no embolic strokes. Patients were followed by clinical evaluation and personal or telephone interviews. Over a mean 18-month follow-up (range 12-35), 8 (73%) patients remained asymptomatic, while 3 (27%) had permanent deficits, 2 related to the procedure and 1 owing to distal disease
Conclusions:
Intracranial VA or BA angioplasty and stenting alleviated symptoms in patients with vertebrobasilar ischemia despite best medical management and may prevent stroke.