Abstract
BackgroundTo evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging.MethodAfter strict screening of 67 patients with symptomatic severe basilar artery stenosis (70–99%) with atherosclerotic stenosis, 67 patients with symptomatic recurrence after intensive drug treatment were treated with intravascular balloon dilatation and Enterprise stent implantation. Any stroke or death within 30 days after operation and any stroke and restenosis during medium-and long-term follow-up were recorded.Results①The mean age of 67 patients (67lesions) was 57 ± 8 years old, and the technical success rate was 100%; ②Preoperative angiography showed that the collateral circulation was poor, and TICI was 1-2a while postoperative angiography showed that TICI was significantly improved to 2b-3; ③The average preoperative stenosis rate was 82 ± 9%, and the postoperative stenosis rate was reduced to 17 ± 10%; ④Before surgery, abnormal perfusion was found in the posterior circulation CTP; After the postoperative re-examination, the posterior circulation of CTP perfusion was significantly improved; ⑤Postoperative symptoms and neurological conditions improved significantly; ⑥Complications of perforating branch event occurred in 1 case after operation, and symptoms were relieved after more than 1 month of medication treatment, and mild neurological dysfunction remained. 1 case developed subacute thrombosis in the stent, which improved after active intra-arterial thrombolysis, and there was no residual neurological dysfunction; and 1 case of micro-guide wire being trapped by the distal vasospasm. ⑦67 patients were followed up by telephone, WeChat or imaging for 36–66 months.ConclusionsIn summary intravascular balloon dilation + Enterprise stent implantation is safe and effective for the treatment of symptomatic severe atherosclerotic stenosis of the basilar artery, with high technical success rate, low perioperative complications, and good mid-term and long-term effects.
Highlights
To evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging
Inclusion criteria for patients in the present study were as follows: (1) 18–80 years old; (2) 70–99% extent of stenosis with the length of stenosis being less than 15 mm, as measured based on the standard vertebral method established by the Warfarin–Aspirin Symptomatic Intracranial Disease (WASID) trial [6], using the same image magnification in digital subtraction angiography (DSA); (3) standard medical drug treatment for 1–3 months and non-disabling posterior circulation infarct (PCI) and transient ischemic attack (TIA) recurrence in the area receiving blood supply from the affected vessels; and (4) the last episode of symptoms occurring at least 3 weeks before the scheduled operation
Preoperative assessments All patients were preoperatively assessed by multimodal imaging, including transcranial Doppler sonography (TCD), computed tomography angiography (CTA), computed tomography perfusion (CTP), magnetic resonance angiography (MRA), diffusion weighted imaging (DWI), high-resolution magnetic resonance imaging (HR-MRI), perfusion-weighted imaging (PWI), and digital subtraction angiography (DSA) of the entire cerebrovascular system
Summary
To evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging. According to the Chinese Intracranial Atherosclerosis (CICAS) study [4], the prevalence of intracranial atherosclerotic stenosis (ICAS) is as high as 46.6% in the Chinese population of stroke patients, and the basilar artery is the most vulnerable component of the affected blood vessels. Development of effective interventions to prevent stroke in patients with ICAS is necessary, especially for those with symptomatic ICAS To this aim, leveraging technological advancements and updated materials may facilitate development of safer and more efficacious endovascular stent implantations for the treatment of symptomatic severe basilar artery stenosis. The present study screened 67 patients with symptomatic atherosclerotic stenosis in the basilar arteries and evaluated the safety, as well as the medium- and long-term effects, of endovascular interventions with an Enterprise stent system
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