Medium- and Long-Term Effects of Endovascular Treatments for Severely Stenotic Basilar Arteries Supported by Multimodal Imaging

Abstract

Background: To evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging.Method: After strict screening of 67 patients with symptomatic severe basilar artery stenosis (70%- 99%) with atherosclerotic stenosis, 67 patients with symptomatic recurrence after intensive drug treatment were treated with intravascular balloon dilatation and Enterprise stent implantation. Any stroke or death within 30 days after operation and any stroke and restenosis during medium-and long-term follow-up were followed up.Results: The mean age of 67 patients(67lesions) was 57 ± 8 years old, and the technical success rate was 100%; ②Preoperative angiography showed that the collateral circulation was poor, and TICI was 1-2a while postoperative angiography showed that TICI was significantly improved to 2b-3; ③The average preoperative stenosis rate was 82 ± 9%, and the postoperative stenosis rate was reduced to 17 ± 10%; ④Before surgery, abnormal perfusion was found in the posterior circulation CTP; After the postoperative re-examination, the posterior circulation of CTP perfusion was significantly improved; ⑤Postoperative symptoms and neurological conditions improved significantly; ⑥Complications of perforating branch event occurred in 1 case after operation, and symptoms were relieved after more than 1 month of active treatment, and mild neurological dysfunction remained. 1 case developed subacute thrombosis in the stent, which improved after active intra-arterial thrombolysis, and there was no residual neurological dysfunction; and 1 case of microlead wire being clamped by the distal vasospasm. ⑦67 patients were followed up by telephone, WeChat or imaging for 36–66 months. 55 cases were regularly reviewed with images. Intrastenting stenosis occurred in 4 cases, and 12 cases were followed up by phone or WeChat.The average follow-up period was 56 ± 21 months (36–66 months). No TIA or stroke occurred during follow-up.Conclusions: In summary intravascular balloon dilation + Enterprise stent implantation is safe and effective for the treatment of symptomatic severe atherosclerotic stenosis of the basilar artery, with high technical success rate, low perioperative complications, and good mid-term and long-term effects.