Stent-Assisted Angioplasty of Intracranial Vertebrobasilar Atherosclerosis: The Best Therapeutic Option in Recurrent Transient Ischemic Events Unresponsive to Anticoagulant Treatments

Abstract

Atherosclerotic stenosis of the posterior circulation refractory to medical treatment generally has a poor prognosis resulting in a high morbidity-mortality rate and the recurrence of ischemic events. Extracranial bypass in the vertebrobasilar system is possible but is also associated with high morbidity (3–21%) and mortality (13–55%)1,2, and has not been demonstrated to reduce the risk of stroke. Percutaneous angioplasty alone has also not shown favorable results, and further, has been associated with a remarkable number of complications. The improvement resulting from endovascular therapy has taken the treatment of this pathology to a new dimension. We describe eight patients with severe symptomatic basilar artery stenosis who, in addition to medical therapy, were treated by our service with angioplasty and stent placement. Three of them received urgent treatment. All patients suffering from severe stenosis of the basilar artery were treated by the insertion of balloon expandable stents. The degree of pre-stent stenosis was approximately 80% in all cases, and was reduced to 5–10% after the stent implant. There were no complications during treatment. There has not been a recurrence of symptoms or a new ischemic lesion during the one-year follow-up period. Endovascular therapy with a balloon expandable stent or angioplasty plus stent are presented as improved choices for treatment of patients with severe basilar artery stenosis refractory to medical treatment.