Elective stenting of symptomatic basilar artery stenosis

Background and Purpose-Percutaneous angioplasty of the intracranial arterie s still carries the risk of dissection, with acute closure and embolization . Stenting has been shown to improve the safety and durability of angioplas ty in every circulatory bed in which it has been applied. However, stenting of the intracranial arteries has been limited by the availability of stent s that can be reliably deployed intracranially. Methods-Twelve patients underwent elective stenting of the basilar artery a fter episodes of vertebrobasilar ischemia. In all patients, either medical therapy had failed or the patient had a contraindication for long-term anti coagulation. Information from independent neurological examinations, quanti tative angiography, and clinical follow-up was collected. Differences betwe en pretreatment and posttreatment degree of stenoses were subjected to 1-wa y ANOVA for repeated measures. Results-There were 10 men and 2 women, all white, aged 40 to 82 years (mean age, 62.6 years). Stent placement was successful in all patients, leading to statistically significant changes in the degree of stenosis, from 71.4% (range, 53% to 90%) to 10.3% (range, 0% to 36%) (P<0.0001). There were no d eaths, stent thromboses, perforations, ruptures, or myocardial infarctions. Clinical follow-up was available for 0.5 to 16 months (mean, 5.9 months). One patient had nonspecific symptoms, and another had a transient ischemic attack. All other patients remained asymptomatic. Conclusions-Elective stenting of the basilar artery is feasible, with minim al risk to the patient. Its impact on long-term stroke prevention and its d urability are unknown and will require further study.