Endovascular treatment for aggressive vertebrobasilar stenosis due to giant cell arteritis: illustrative cases

Giant cell arteritis (GCA) infrequently presents with progressive symptomatic vertebrobasilar stenosis. Vertebrobasilar GCA is often refractory to medical treatments and can lead to short-term ischemic stroke recurrence, which is associated with a poor prognosis. Endovascular treatment (EVT) is a therapeutic option; however, the optimal timing and indications for its application remain unclear.

This study reports two patients with vertebrobasilar GCA who exhibited repeated ischemic strokes in the vertebrobasilar territory, along with progressive severe stenosis and occlusion of the bilateral vertebral arteries, despite receiving medical therapy. They were successfully treated with balloon angioplasty, and there were no subsequent occurrences of stroke or restenosis. A review was conducted of six cases of vertebrobasilar GCA treated with EVT. All patients had bilateral lesions and experienced recurrent strokes within 30 days. Angiography suggested ischemic complications in vertebrobasilar GCA resulting from hemodynamic ischemia caused by stenosis rather than intradural vasculitis. The improved blood flow through EVT alleviated patient symptoms and prevented recurrent strokes.

Some patients with vertebrobasilar GCA exhibit rapid stenosis progression and repeated hemodynamic ischemia despite medical therapy. EVT is a potential strategy for treating medically refractory vertebrobasilar GCA. Performing EVT prior to recurrent infarctions can lead to favorable outcomes. https://thejns.org/doi/10.3171/CASE24404.