TRANSLUMINAL ANGIOPLASTY FOR ARTERIOSCLEROTIC DISEASE OF THE DISTAL VERTEBRAL AND BASILAR ARTERIES

Objective-Percutaneous transluminal angioplasty (PTA) for the distal v ertebral and basilar artery is now being performed in selected patient s with haemodynamically significant lesions of the posterior cerebral circulation. Its effect and overall results were examined. Patients an d methods-A balloon dilatation catheter specifically developed for the se procedures, with a 2.0-3.5 mm balloon diameter, at 6 atmospheres of pressure, was used. Angioplasty was performed in 12 patients (includi ng six whose initial results have been reported) with angiographically documented stenotic lesions involving either the intracranial vertebr al artery (C1-C2 portion) or the basilar artery, and satisfying the fo llowing criteria: (1) clinical symptoms suggestive or consistent with a transient ischaemic attack refractory to medical treatment, or small infarction of the posterior circulation; and (2) angiographically doc umented stenosis greater than 70%. Two of 12 patients had complete thr ombosis of the distal vertebral and basilar artery and PTA was perform ed after successful intra-arterial thrombolysis. Results-Successful re sults, without complications, were obtained in eight patients, with co mplete resolution of vertebrobasilar ischaemic symptoms. complications occurred in four patients including two with vessel dissection, and t wo with thromboembolism. The two patients with acute arterial dissecti on were reoperated but developed smalt infarctions with permanent neur ological deficits. The two patients with thromboembolic complication s howed transient neurological deficit. The overall stenosis ratio decre ased from a mean of 84% pretreatment to 44% after the angioplasty proc edure. Restenosis occurred in two patients. Long term clinical follow up in 11 patients who survived more than six months showed resolution of ischaemic symptoms after PTA in all except for one with a restenosi s who had recurrent transient ischaemic attacks. Conclusion-Translumin al angioplasty may be an effective procedure to treat vertebrobasilar ischaemia secondary to high grade arteriosclerotic disease affecting e ither the distal vertebral or basilar artery regions that do not respo nd to medical treatment.