Contrast-Enhanced Transcranial Color-Coded Duplex Sonography Versus Computed Tomography and Magnetic Resonance Angiography in the Follow-up of Basilar Stenting

Abstract

The annual risk of stroke in patients with basilar artery stenosis is 2.5% to 11%, and even despite aggressive medical treatment, the prognosis of basilar artery thrombosis is fatal. For these reasons, invasive therapeutic approaches have been developed for cases of stroke due to vertebrobasilar circulation stenosis and occlusion. 1 In specialized centers, both intra-arterial thrombolysis performed in cases of basilar occlusion and intracranial stenting nowadays are becoming available suitable procedures to restore vascularization in cases of vertebrobasilar stenosis. 2,3 Nonetheless, restenosis is the major complication, with rates of 30% to 41% and an overall annual periprocedural complication rate of 6.6%. 4,5 It is therefore important to perform an accurate postprocedural follow-up to determine stent lumen patency. Conventional digital subtraction angiography (DSA) is still the most sensitive technique for visualizing the residual lumen after stenting, but it is invasive and not free of complications. Postprocedural follow-up is then usually performed by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA). These techniques are both expensive and have limitations due to stent-induced artifacts, which may hide the residual lumen. 2 Transcranial color-coded duplex sonography (TCCD) has been a well-established diagnostic tool for visualization of the basal cerebral arteries since the early 1990s, although it is limited by the quality of the temporal acoustic bone window.6 With the introduction of sonographic contrast agents, vessel visualization has become easier and feasible in daily practice, at the bedside of the patient, with low costs and excellent results. 7 We report a case of a patient with a stroke and basilar artery stenosis who underwent a stenting procedure and follow-up studies with MRA, CTA, DSA, and TCCD.