Transluminal angioplasty and stenting versus conservative treatment in patients with symptomatic basilar artery stenosis

Maier, Ilko; Karch, André; Lipke, Christina; Behme, Daniel; Mpotsaris, Anastasios; Kabbasch, Christoph; Liebig, Thomas; Faymonville, Andrea Maria; Reich, Arno; Nikoubashman, Omid; Buhk, Jan‐Hendrik; Schoenfeld, Patrick von; Weber, W.; Mikolajczyk, Rafael; Bähr, Mathias; Knauth, Michael; Kallenberg, Kai; Liman, Jan

doi:10.1007/s00062-016-0528-x

Cited by 28 publications

(19 citation statements)

References 20 publications

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“…Although the results of both the SAMMPRIS and VISSIT (the Vitesse Intracranial Stent Study for Ischemic Stroke Therapy) trials supported the use of aggressive medical management as being superior to stent therapy ( 6 , 8 ), some prospective and retrospective studies from both Europe and Asia reported encouraging results for endovascular treatment ( 9 – 14 ). In this article, we will review the current literature related to angioplasty or stent placement for ICAS and discuss the current debate regarding three aspects: patient-, intervention-, and operator-related factors.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Intracranial Atherosclerotic Stenosis: Current Debates and Future Prospects

et al. 2018

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Intracranial atherosclerotic stenosis (ICAS) is a common cause of transient ischemic attack (TIA) and ischemic stroke. Endovascular treatment, including balloon angioplasty alone, balloon-mounted stents, and self-expandable stent placement with or without prior angioplasty, is an alternative to medical treatment for the prevention of recurrent TIA or ischemic stroke in patients with ICAS. Although the SAMMPRIS and VISSIT trials supported medical management alone against endovascular treatments, both randomized controlled trials (RCT) were criticized due to flaws relating to patient-, intervention-, and operator-related factors. In this review, we discuss the current debate regarding these aspects and suggest approaches to solve current controversies in the future. In our opinion, endovascular treatment in carefully selected patients, individualized choice of endovascular treatment subtypes, and an experienced multidisciplinary team managing the patient in the pre-, peri- and post-procedural period have the potential to provide safe and efficious treatment of patients with symptomatic ICAS.

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Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Intracranial Atherosclerotic Stenosis: Current Debates and Future Prospects

et al. 2018

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“…The use of stents carries some limitations. The risks and complications associated with this treatment options include periprocedural risks of ischaemia, haemorrhage, intimal dissection, postoperative neurological deficits, and the possibility of in-stent restenosis [5, 7, 11, 12]. Additionally, another periprocedural risk is BA branch occlusion due to the “snowploughing” effect (displacing plaque into branch/perforating arteries during the process of stent deployment) in branches such as the anterior inferior cerebellar artery or the pontine arteries.…”

Section: Discussionmentioning

confidence: 99%

“…Emergent thrombectomy results in better recanalisation rates and clinical outcomes compared to intravenous or intra-arterial thrombolysis [4]. Transluminal angioplasty and stenting of symptomatic BA stenosis reduces stroke recurrence, clinically relevant restenosis, progression, and death [5]. We report a case of acute stroke due to BA occlusion successfully treated with emergency thrombectomy followed by immediate BA stenting.…”

Section: Introductionmentioning

confidence: 99%

Isolated Focal Basilar Artery Stenosis with Acute Stroke Treated with Emergency Thrombectomy and Stenting

et al. 2020

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Strokes due to basilar artery (BA) stenosis/occlusion are devastating. As it is an uncommon cause of stroke, its optimal management is not clearly defined. We present the case of a 68-year-old male with a background history of hypertension, hyperlipidaemia, and smoking who developed a sudden onset of reduced consciousness, myoclonic jerks, generalised weakness, and nausea due to an occluded mid-segment BA with right occipital and left cerebellar infarcts. Emergent cerebral angiography was performed and he was immediately treated by clot retrieval and, due to underlying arterial stenosis, the immediate placement of a stent within 3 h of symptom onset. He had complete neurological recovery within 1 week, with no neurological deficits. He remained well at follow-up 3 months later. Emergency revascularisation of stroke due to BA occlusion should be considered as a treatment option.

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“…However, neither of these methods is efficacious. Conservative management typically includes modification of systemic arterial hypertension, glucose intolerance, serum lipid profile and treatment with antithrombotic agents [ 3 ]. Surgical management of symptomatic vertebral disease includes subclavian vertebral roof-patch angioplasty, reimplantation of the vertebral origin, carotid-vertebral vein bypass and vertebral ostial endarterectomy [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Balloon-expandable stent angioplasty in the treatment of vertebral artery stenosis in the V2 segment.

Cai

Wei

Ren

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionVertebral artery stenosis is a major cause of posterior circulation ischemia in the elderly. There is not a clear consensus on the optimal therapeutic approach for symptomatic extracranial vertebral artery stenosis.AimTo evaluate the feasibility and efficacy of balloon-expandable stent angioplasty in the treatment of vertebral artery stenosis in the V2 segment.Material and methodsFive patients with vertebral artery stenosis (V2 segment) and treatment of percutaneous transluminal stenting from July 2009 to June 2014 were retrospectively evaluated. All patients underwent color Doppler, transcranial color Doppler (TCD), CT angiography (CTA) and cerebral digital subtraction angiography (DSA) preoperatively. Whether there was osseous oppression was determined according to neck computed tomography (CT) and CTA. After the surgery, angiography was performed to determine if there was infarction or bleeding in the intracranial vertebral artery, basilar artery and posterior cerebral artery. The surgical parameters, residual stenosis, complications, etc. were recorded and evaluated. The patients were followed up accordingly.ResultsFive patients (3 males, 2 females; average age of 66 ±4.2, range of 54–75) were enrolled in the study. Balloon-expandable stents were successfully implanted in the 5 patients. The mean residual stenosis after the balloon-expandable stenting (preoperative: average, 87.0 ±6.6%, range: 75–93%) was 12.6 ±7.8% (range: 5–25%). The clinical symptoms disappeared or receded. No serious complications occurred.ConclusionsThe balloon-expandable stent angioplasty seemed to be feasible and efficacious in treating vertebral artery stenosis in the V2 segment. Further study with a large sample size is needed.

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Transluminal angioplasty and stenting versus conservative treatment in patients with symptomatic basilar artery stenosis

Abstract: In this retrospective study we could not reproduce the findings from large RCTs on intracranial stenting. Our data could be considered as a basis for a prospective study on patient selection for PTAS in the basilar artery.

Cited by 28 publications

References 20 publications

Endovascular Treatment of Intracranial Atherosclerotic Stenosis: Current Debates and Future Prospects

Endovascular Treatment of Intracranial Atherosclerotic Stenosis: Current Debates and Future Prospects

Isolated Focal Basilar Artery Stenosis with Acute Stroke Treated with Emergency Thrombectomy and Stenting

Balloon-expandable stent angioplasty in the treatment of vertebral artery stenosis in the V2 segment.

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