Adjuvant use of self-expanding stents in acute atherothrombotic vertebrobasilar occlusions

Recanalization of acute atherothrombotic vertebrobasilar occlusions is a challenging neuroendovascular procedure. A long angiographic occlusion frequently overestimates the true extent of occlusive plaque. We propose the novel use of the Solitaire stent (ev3 Endovascular, Plymouth, MN, USA) as an adjuvant device in the endovascular management of acute atherothrombotic vertebrobasilar occlusions and present our experience. A self-expanding Solitaire stent is fully deployed, but not detached, along the entire occluded segment, from normal-to-normal arterial segment, to obtain a transient endovascular bypass effect and to obtain clear depiction of the true extent and characteristics of the complicated plaque. The Solitaire stent is then retrieved and a stent with greater radial force and lower porosity is deployed across the occlusion to achieve full revascularization of the vertebral and basilar arteries and branches. This technique allows early revascularization (transient endovascular bypass) and permits a clear definition of the underlying plaque, a crucial step for a safe angioplasty.