Abstract
Stenotic lesion rigidity (SLR) has an unclear influence on the outcome of percutaneous transluminal angioplasty and stenting (PTAS) for intracranial arterial stenosis. This study evaluated the outcome of PTAS and the relationship of vertebrobasilar SLR to features on vessel wall MRI (VW-MRI) for identifying pathologies of vertebrobasilar stenosis (VBS) and evaluating PTAS outcome. We retrospectively evaluated the results of PTAS in 31 patients with severe VBS. Stenotic lesions were classified as soft (based on predilatation pressure [PP] ≦ 4 atm) in 15 patients or hard (PP >4 atm) in 16 patients. We examined the relationship of SLR to clinical and MR findings. Patients with hard vs soft lesions had atherosclerosis (8/16 [50.0%] vs 2/15 [13.3%]), dissection (0/16 [0.0%] vs 12/15 [80.0%]), and dissection in atherosclerosis (8/16 [50.0%] vs 1/15 [6.7%], P < 0.0001); high intensity signal on the T1WI of VW-MRI (5/16 [31.3%] vs 14/15 [93.3%]) and iso- to low intensity signal (11/16 [68.7%] vs 1/15 [6.7], P = 0.001), and significant in-stent restenosis (>50%) in 5/15 (33.3%) vs 0/15 (0.0%) (P = 0.0421) in the 30 patients who successfully completed PTAS. Vertebrobasilar SLR correlated well with lesion etiology, findings on VW-MRI, and PTAS outcome. Patients with hard stenotic lesions need close follow-up after PTAS.
Highlights
The present study demonstrates the correlation between vertebrobasilar stenotic lesion rigidity (SLR) and characteristics identified on MRI and Vessel wall-MR imaging (VW-MRI)
We suggest that PTAS, when technically safe to perform, is a good management option in “vertebrobasilar stenosis (VBS) with dissection” cases that show high signals on the T1WI of VW-MRI
To elucidate the complex pathology and character of the arterial wall of intracranial arterial stenosis, we suggest adding high resolution imaging techniques, such as 3-dimensional VW-MRI performed with a high field MR scanner, vascular elastography, susceptibility weighted imaging, or MR-PET
Summary
This retrospective study was approved by the Institutional Review Board of Taipei Veterans General Hospital. Between 2011 to 2018, thirty-one patients (28 males [90.3%], 3 females [9.7%]; mean age 62.2 ± 13.9 [16–85] years old) with severe symptomatic VBS, who had PTAS, were enrolled in this study (Table 1, supplementary information). All patients received medical treatment on presentation of symptoms including impaired consciousness due to cerebral ischemia in the vertebrobasilar territory. Besides having clinical findings of atherosclerosis and dissection, patients with DA can present with intimal dissection on angiography, or calcified plaques on CT or MRI, or both. The indications for PTAS in our cases of VBS were: 1) more than 70% arterial stenosis on imaging study; 2) medically refractory neurological symptoms, including rapidly deteriorated consciousness level. PTAS was performed on an urgent basis when neurological symptoms were recurrent and rapidly becoming more severe
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