Clinical Results of Percutaneous Transluminal Angioplasty and Stenting for Intracranial Vertebrobasilar Atherosclerotic Stenoses and Occlusions

Abstract

Eighteen patients with intracranial vertebrobasilar stenosis and occlusion were treated by PTA or stenting. In 11 of 18 cases, only PTA was performed and in seven of 18 cases, we used stents. The mean stenosis before and after PTA/stenting was 82.8% and 22.3%, respectively. In 11 cases of PTA only, the stenotic rate decreased from 81.8% to 29.6%, while 85.0% of the stenotic rate remarkably reduced to 6.0% in seven cases of stenting.

The 30 days morbidity and 30 days mortality rate were 5.5% and 5.5%, respectively. There was only one haemorrhagic complication (cerebellar haemorrhage) in cases of stenting, and no ischemic events during or after the procedures. Restenosis (more than 50% stenosis) occurred in four of 18 cases (22.2%) during mean follow-up period of 12 months. Two patients with VA occlusion before treatment, developed restenosis and reocclusion. Complete total occlusion seems to be a high-risk lesion and strict follow-up is required.

In this study, PTA/stenting for intracranial vertebrobasilar artery stenosis or occlusion is an effective treatment, but strict indications may be required because procedure-related 30 days morbidity rate was 5.5% in addition to unclear natural history.

Keywords

PTA/stenting vertebrobasilar stenosis complications

Get full access to this article

View all access options for this article.

References

The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group: Prognosis of patients with symptomatic vertebral or basilar artery stenosis. Stroke 29: 1389–1392, 1998.

Qureshi

Suri

MFK

: Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: A multicenter study. Neurosurgery 52: 1033–1040, 2003.

Hopkins

Budny

: Complications of intracranial bypass for vertebrobasilar insufficiency. J Neurosurg 70: 207–211, 1989.

Nahser

Henkes

: Intracranial vertebrobasilar stenosis: Angioplasty and follow-up. Am J Neuroradiol 21: 1293–1301, 2000.

Rasmussen

Perl

II : Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: An initial experience. J Neurosurg 92: 771–778, 2000.

Gomez

Mirsa

: Elective stenting of symptomatic basilar artery stenosis. Stroke 31: 95–99, 2000.

Levy

Horowitz

: Transluminal stent-assisted angioplasty of the intracranial vertebrobasilar system for medically refractory, posterior circulation ischemia: Early results. Neurosurgery 48: 1215–1223, 2001.

Levy

Hanel

: Staged stent-assisted angioplasty for symptomatic intracranial vertebrobasilar artery stenosis. J Neurosurg 97: 1294–1301, 2002.

Gress

Smith

: Angioplasty for intracranial symptomatic vertebrobasilar ischemia. Neurosurgery 51: 23–29, 2002.

10.

Mori

Kazita

: Cerebral angioplasty and stenting for intracranial vertebral atherosclerotic stenosis. Am J Neuroradiol 20: 787–789, 1999.

11.

Mehran

Dangas

: Angiographic patterns of in-stent restenosis Classification and implications for long-term outcome. Circulation 100: 1872–1878, 1999.