Use of far field basilar artery stenting for recurrent middle cerebral artery ischemia

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Intracranial angioplasty and stenting are standard for stroke prevention in stenotic disease.
• Limited options exist for chronic proximal feeding vessel occlusion.
• Improving collateral flow is crucial in complex cerebrovascular cases.

Observation:

• A case study involving a patient with recurrent middle cerebral artery (MCA) strokes due to internal carotid artery occlusion.
• The patient had undergone a superior temporal artery (STA)-MCA bypass without complete resolution of symptoms.
• Basilar artery (BA) stenting was performed to enhance collateral circulation.

Findings:

• Basilar artery stenting led to complete cessation of MCA ischemia.
• Cerebrovascular reserve improved significantly, as evidenced by single-photon emission CT.
• The procedure was deemed safe and effective in mitigating recurrent MCA infarctions.

Implications:

• Far-field intracranial angioplasty and stenting can be a viable strategy for improving collateral flow.
• This approach should be considered for selected patients with chronic occlusive cerebrovascular disease who have failed other treatments.
• It expands therapeutic options for complex stroke prevention.