Intracranial posterior circulation stenting

Abstract

There is debate about the indications for and efficacy of angioplasty and stenting vs surgery for treatment of symptomatic and asymptomatic extracranial carotid stenosis. Ongoing randomized clinical trials may help guide future therapy. Data are becoming available regarding endovascular angioplasty and stenting for treatment of extracranial and intracranial arterial narrowing in the posterior circulation. The vertebrobasilar circulation supplies the most critical brainstem structures so morbidity and mortality resulting from posterior circulation ischemia is high.1 Anatomic constraints have precluded surgical attempts to revascularize the intracranial portions of these vessels, currently leaving endovascular treatment as the best alternative to medical therapy. Earlier caution and concerns about serious morbidity associated with endovascular manipulation of the vertebral and basilar arteries have mostly been allayed by reports of technical success when angioplasty and stent delivery is performed in the posterior circulation. Despite the use of antithrombotic agents, stroke rates remain frustratingly high in the population with ≥50% symptomatic intracranial stenosis.2 The advent of a safe adjunctive or alternative therapy that would reduce …