Combined endovascular and open surgery for four-vessel cerebrovascular occlusive disease

Purpose: To report a case of bilateral simultaneous percutaneous translumin al angioplasty and stenting of the intracranial vertebral arteries prior to staged bilateral carotid endarterectomy. Case Report: A 68-year-old man presented with a 3-month history of recurren t, intermittent left-sided Weakness and diplopia. Imaging defined bilateral 80% to 99% internal carotid artery stenoses and >90% stenoses of both dist al vertebral arteries at the level of the foramen magnum. Bilateral intracr anial vertebral artery stenting was performed, followed by staged carotid e ndarterectomies. No complications occurred, and the patient recovered uneve ntfully from all 3 procedures. He remains symptom- and event-free 20 months later. Conclusions: Our initial success in this case indicates a role for percutan eous transluminal angioplasty and stenting as-an alternative to open surger y for intracranial vertebral artery stenosis.