Transluminal stent-assisted angioplasty of the intracranial vertebrobasilar system for medically refractory, posterior circulation ischemia: Early results

OBJECTIVE: Symptomatic vertebrobasilar artery stenosis portends a poor prog nosis, even with medical therapy. Surgical intervention is associated with considerable morbidity, and percutaneous angioplasty alone has demonstrated mixed results, with significant complications. Recent advances in stent te chnology have allowed for a novel treatment of symptomatic, medically refra ctory, vertebrobasilar artery stenosis. We report on a series of patients w ith medically refractory, posterior circulation stenosis who were treated w ith transluminal angioplasty and stenting at two medical centers in the Uni ted States. METHODS: A retrospective analysis of data for 11 consecutive patients with symptomatic, medically refractory, intracranial, vertebral or basilar arter y stenosis was performed. All patients were treated with percutaneous trans luminal angioplasty and stenting. Short-term clinical and angiographic foll ow-up data were obtained. RESULTS: Among 11 patients who were treated with stent-assisted angioplasty of the basilar or vertebral arteries, there were three periprocedural deat hs and one delayed death after a pontine stroke. Other complications includ ed a second pontine infarction, with subsequent residual diplopia. The rema ining seven patients (64%) experienced symptom resolution and have resumed their preprocedural activities of daily living. Angiographic follow-up exam inations demonstrated good patency of the stented lesions for five of seven survivors (71 %); one patient exhibited minimal intrastent intimal hyperpl asia, and another patient developed new stenosis proximal to the stent and also developed an aneurysm within the stented portion of the basilar artery . The last patient exhibited 40% narrowing of the treated portion of the ve ssel lumen. CONCLUSION: Recent advances in stent technology allow negotiation of the pr oximal posterior circulation vasculature. Although the treatment of vertebr obasilar artery stenosis with angioplasty and stenting is promising, long-t erm angiographic and clinical follow-up monitoring of a larger patient popu lation is needed.