T. Terada et al., Combined surgery and endovascular stenting for basilar artery stenosis refractory to balloon angioplasty: Technical case report, ACT NEUROCH, 143(5), 2001, pp. 511-516
The authors report a case of symptomatic basilar artery stenosis treated by
stenting via the surgically exposed C1 vertebral artery. This case was ini
tially treated by percutaneous transluminal angioplasty via a transfemoral
route but resulted in unsatisfactory dilatation. Stenting via a transfemora
l route also resulted in failure because of the: coiling of the proximal ve
rtebral artery. Direct puncture of the vertebral artery beyond the coiling
portion was tried but a stent could not be delivered beyond the C2 vertebra
e, Finally, the vertebral artery was surgically exposed between C1 and the
occipital bone and a stent was introduced into the lesion from this portion
under fluoroscopic control. The basilar artery was fully opened by stentin
g without new neurological deficits. Stenting of the basilar artery via a t
ransfemoral route is not always possible even with newer generation stents
if the vertebral artery has elongated tortuous curves. Combined surgery and
endovascular stenting is one of the alternatives in such cases including o
ur case.