T. Terada et al., TRANSLUMINAL ANGIOPLASTY FOR ARTERIOSCLEROTIC DISEASE OF THE DISTAL VERTEBRAL AND BASILAR ARTERIES, Journal of Neurology, Neurosurgery and Psychiatry, 60(4), 1996, pp. 377-381
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.