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Flow diverter as a rescue therapy for a complicated basilar angioplasty
Murat Velioglu1, Ersin Ozturk, Guner Sonmez
1Department of Radiology, GATA Haydarpaşa Teaching Hospital, İstanbul, Turkey. muratvelix@yahoo.com
Insights
Flow diverters (FDs) offer a rescue therapy for complex basilar artery atherosclerosis interventions. This case demonstrates FD use in complicated angioplasty, successfully treating dissection and preventing rebleeding in a stroke patient.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Intracranial atherosclerotic disease is a leading cause of ischemic stroke.
- Previous stenting trials for intracranial stenosis showed high complication rates.
- Flow diverters (FDs) are primarily used for complex aneurysms, altering blood flow dynamics.
Observation:
- A 72-year-old female presented with stroke symptoms due to critical mid-basilar artery stenosis.
- Angiography revealed poor collateralization, necessitating intervention to improve posterior circulation.
- The patient underwent angioplasty, which was complicated by arterial dissection and perforation.
Findings:
- A flow diverter (FD) was successfully deployed as a rescue therapy following angioplasty complications.
- The FD effectively managed the dissection and perforation, preventing rebleeding.
- The patient achieved good clinical and angiographic outcomes post-intervention.
Implications:
- Flow diverters can be a valuable rescue option in complex intracranial angioplasty procedures.
- This case highlights the potential utility of FDs beyond aneurysm treatment in managing atherosclerotic disease complications.
- Further research may explore FD application in challenging atherosclerotic stenosis cases where traditional methods fail.
Abstract:
Intracranial atherosclerotic disease is a major cause of ischemic stroke. Stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis was terminated prematurely due to a high stroke and death rate in patients randomized for intracranial stent placement. However, for some patients, angioplasty and/or stent placement remains the best approach. Flow diverters (FDs) are designed to produce a hemodynamic flow diversion by constituting a laminar flow pattern in the parent artery and are mainly used in non-ruptured complex wide-neck aneurysms as well as in ruptured aneurysms. Herein, we present a case where an FD was used in a complicated angioplasty for basilar artery atherosclerosis. A 72-year-old female patient was admitted to our hospital with left side weakness and vertigo. Her diffusion magnetic resonance imaging and magnetic resonance angiography showed right-sided pontine and left-sided occipital acute infarcts with left-sided pontine and right-sided occipital chronic infarcted areas and preocclusive mid-basilar stenosis. The patient was under supervised medical treatment. Despite chronic brain stem and occipital infarcts her modified Rankin Scale was 2. Diagnostic angiography showed no posterior communicating arteries and no pial-pial collaterals and a critical mid-basilar artery stenosis. We decided to perform intracranial angioplasty to increase the perfusion of posterior circulation and reduce the risk of additional embolic infarcts. Angioplasty was complicated with dissection and vessel perforation. We used an FD for rescue therapy to avoid rebleeding. The patient was discharged with good clinical and angiographic results.
