Transluminal stent-assisted angiplasty of the intracranial vertebrobasilar system for medically refractory, posterior circulation ischemia: early results

OBJECTIVE: Symptomatic vertebrobasilar artery stenosis portends a poor prognosis, even with medical therapy. Surgical intervention is associated with considerable morbidity, and percutaneous angioplasty alone has demonstrated mixed results, with significant complications. Recent advances in stent technology have allowed for a novel treatment of symptomatic, medically refractory, vertebrobasilar artery stenosis. We report on a series of patients with medically refractory, posterior circulation stenosis who were treated with transluminal angioplasty and stenting at two medical centers in the United States. METHODS: A retrospective analysis of data for 11 consecutive patients with symptomatic, medically refractory, intracranial, vertebral or basilar artery stenosis was performed. All patients were treated with percutaneous transluminal angioplasty and stenting. Short-term clinical and angiographic follow-up data were obtained. RESULTS: Among 11 patients who were treated with stent-assisted angioplasty of the basilar or vertebral arteries, there were three periprocedural deaths and one delayed death after a pontine stroke. Other complications included a second pontine infarction, with subsequent residual diplopia. The remaining seven patients (64%) experienced symptom resolution and have resumed their preprocedural activities of daily living. Angiographic follow-up examinations demonstrated good patency of the stented lesions for five of seven survivors (71%); one patient exhibited minimal intrastent intimal hyperplasia, and another patient developed new stenosis proximal to the stent and also developed an aneurysm within the stented portion of the basilar artery. The last patient exhibited 40% narrowing of the treated portion of the vessel lumen. CONCLUSION: Recent advances in stent technology allow negotiation of the proximal posterior circulation vasculature. Although the treatment of vertebrobasilar artery stenosis with angioplasty and stenting is promising, long-term angiographic and clinical follow-up monitoring of a larger patient population is needed.