Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: an initial experience

Object. Patients with intracranial vertebrobasilar artery (VBA) atheroscler otic occlusive disease have few therapeutic options. Unfortunately, VBA tra nsient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experien ce with eight patients in whom medically refractory TIAs secondary to intra cranial posterior circulation atherosclerotic occlusive lesions were treate d with stent-assisted angioplasty. Methods. Eight patients (six men), ranging in age from 43 to 77 years, expe rienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed sever e distal vertebral (four patients), proximal basilar tone patient), or prox imal and midbasilar stenoses (three patients). Aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, an d this regimen was maintained by the patients on discharge. Patients underw ent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all p atients before and after the procedure. The VBAs in all patients were successfully revascularized with 7 to 28% res idual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid he morrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are a symptomatic up to 8 months postoperatively. Conclusions. Although primary intracranial VBA angioplasty with stent inser tion is technically feasible, complications associated with the procedure c an be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into ca tastrophic VBA insufficiency.