Endovascular treatment of multiple severe atherosclerotic stenoses with cerebral hypoperfusion. Case report

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Atherosclerotic disease commonly affects cerebral arteries, leading to significant neurological deficits.
• Multiple severe stenoses in both internal carotid and vertebral arteries pose a complex clinical challenge.
• Reduced cerebral perfusion and vascular reserve can manifest as transient ischemic attacks or syncope.

Purpose of the Study:

• To evaluate the feasibility and efficacy of endovascular treatment for multiple severe atherosclerotic stenoses in cerebral arteries.
• To assess the impact of angioplasty and stenting on cerebral perfusion and neurological symptoms.

Main Methods:

• Cerebral angiography was used to identify multiple severe atherosclerotic stenoses in bilateral internal carotid and vertebral arteries.
• Single-photon emission computed tomography (SPECT) was performed to assess cerebral perfusion and vascular reserve.
• Balloon-expandable stents were deployed in the vertebral artery stenoses, followed by angioplasty and stenting of the internal carotid arteries.

Main Results:

• Angioplasty and stenting of vertebral artery stenoses preceded bilateral carotid interventions.
• The patient experienced resolution of syncope post-vertebral artery stenting, suggesting improved posterior circulation.
• Subsequent carotid angioplasty and stenting were performed safely, indicating successful management of complex cerebrovascular disease.

Conclusions:

• Endovascular intervention, including angioplasty and stenting, is a feasible treatment option for patients with multiple severe atherosclerotic stenoses in cerebral arteries.
• Pre-operative hemodynamic assessment is crucial for planning successful interventions.
• Successful revascularization can significantly improve cerebral perfusion and resolve associated neurological symptoms like syncope.