Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries

Abstract

Transluminal angioplasty for hemodynamically significant stenosis (> 70%) involving the posterior cerebral circulation is now being performed by the authors in selected cases. A total of 42 lesions affecting the vertebral or basilar artery have been successfully treated by percutaneous transluminal angioplasty techniques in 41 patients. The lesions involved the proximal vertebral artery in 34 cases, the distal vertebral artery in five, and the basilar artery in three. Patients were examined clinically at 1 to 3 and 6 to 12 months after angioplasty. Three (7.1%) permanent complications occurred, consisting of stroke in two cases and vessel rupture in one. There were four (9.5%) transient complications (< 30 minutes): two cases of vessel spasm and two of cerebral ischemia. Clinical follow-up examination demonstrated improvement of symptoms in 39 cases (92.9%). Radiographic follow-up studies demonstrated three cases (7.1%) of restenosis involving the proximal vertebral artery; two were treated by repeat angioplasty without complication, and the third is being followed clinically while the patient remains asymptomatic. In patients with significant atherosclerotic stenosis involving the vertebral or basilar artery territories, transluminal angioplasty may be of significant benefit in alleviating symptoms and improving blood flow to the posterior cerebral circulation.

Successful Endovascular Therapy for Acute Basilar Thrombosis in an Adolescent

“…44 -49 Complication rates are estimated to be substantial and may stem from vessel rupture, thromboembolic events, or damage to small perforators and subsequent infarction. 45,47,48 It is only because the prognosis of basilar occlusion is so grave that these risks can be both tolerated and ethically justified. Our study documents the sequential use of chemical, followed by mechanical means of recanalization of the basilar artery.…”

Transluminal Angioplasty and Stenting for Intracranial Vertebrobasilar Occlusive Lesions in Acute Stroke Patients

“…[2][3][4][5][6][7][8][9][10] In the present study, TAS for occluded lesions was shown to be technically feasible with a high success rate, similar to treatment of stenotic lesions. Technical success in treating the occluded lesion depends on the freshness of the occluded clots and the occluded segment being short enough for the microguidewire to pass through it; such conditions are frequently encountered in the acute stroke stage.…”

“…The procedure-related complication rate in the present study was higher than the reported rates in previous studies performed mainly for stenotic lesions and in the chronic stroke stage. [2][3][4][5][6][7][8][9][10] This may be because TAS for occluded lesions tends to induce distal embolism, intracranial hemorrhage involving hemorrhagic transformation and cerebral hyperperfusion syndrome, and vessel injury or rupture in comparison with the treatment of stenotic lesions. Because distal embolism tends to occur for a lesion crossed by a microguidewire, balloon catheter, or stent and is especially common with occluded lesions, the use of an embolic protection device with proximal flow control may reduce the incidence of this complication.…”

“…Angioplasty and/or stent placement for the IVBA are becoming increasingly common, [1][2][3][4][5][6][7][8][9][10] and recanalization therapy with angioplasty and/or stent placement has been reported anecdotally for the IVBA, even in the acute stroke stage. 4,10 However, most case series have included patients of varied background: patients in acute and chronic stroke stages 4 or acute stroke patients with lesions of the anterior circulation.…”

Intracranial Atherosclerosis

“…Patients with symptomatic or asymptomatic, severe intracranial atherosclerotic stenosis who were at high risk for stroke or death were included (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41).…”