Endovascular treatment for intracranial vertebrobasilar artery stenosis

We describe our experience with endovascular treatment for symptomatic intracranial vertebrobasilar artery stenosis.

Forty-four patients with intracranial vertebrobasilar artery stenosis (37 vertebral arteries, 7 basilar arteries) were treated with endovascular surgery. Indication criteria for the treatment were (1) medically refractory symptomatic patients; (2) angiographic stenosis of more than 60 %; and (3) short lesion (<15 mm). Under local anesthesia, balloon angioplasty was first performed in all patients. Stenting was performed only in cases with insufficient dilatation, dissection, or restenosis after balloon angioplasty. The degree of stenosis, which was 83 % before treatment, was reduced to 23 % after treatment. The rate of stroke and death within 30 days was 2.3 %. Nine patients (20.5 %) developed restenosis within 6 months. Of these, four patients were symptomatic. All symptomatic patients with restenosis were successfully treated with balloon angioplasty or stenting.

Endovascular treatment for vertebrobasilar artery stenoses is feasible and safe in selected patients. Restenosis may be an important cause of recurrent stroke. Therefore, close clinical and neuroradiological follow-ups are essential for patients treated with endovascular surgery to improve long-term results.