Primary stenting for high-grade basilar artery stenosis

Abstract

We report two patients with symptomatic high-grade stenosis of the basilar artery refractory to appropriate maximal medical therapy in whom endovascular stenting was performed successfully without preliminary balloon angioplasty. Excellent angiographic results were achieved and there were no procedural or periprocedural complications. The patients were asymptomatic and neurologically intact at a mean clinical follow-up of 6.5 months. Primary stenting of basilar artery stenosis may be an alternative to balloon angioplasty for patients with symptomatic lesions refractory to medical therapy or in whom anticoagulation is contraindicated.

fig 1.

Anteroposterior oblique views of the basilar artery. A, Eccentric high-grade (>75%) stenosis of the lower basilar artery above the origin of the right AICA. The left AICA arises from the left PICA. Note bilateral stenosis of the posterior cerebral arteries (arrows) and a stenosis involving the distal left vertebral artery at the vertebrobasilar junction. B, Stent is positioned across the stenosis without preliminary balloon angioplasty. C, After stent deployment, normal vessel lumen is restored. Although not obvious on this image, the inferior margin of the stent covers the right AICA origin; however, the vessel continues to opacify normally (arrow). D, Nonsubtracted lateral oblique view of the posterior fossa shows the basilar artery metallic stent posterior to the clivus (arrow).

fig 2.

A and B, Anteroposterior (A) and lateral (B) views of the basilar artery show an eccentric high-grade (>70%) stenosis of the lower basilar artery projecting from the anterior wall (arrow, B). The AICAs originate immediately above the lesion. C, Anteroposterior view of the basilar artery shows positioning of the stent across the lesion without preliminary balloon angioplasty. Note that positioning of the stent delivery catheter across the stenosis results in significant flow compromise, confirming the high-grade nature of this lesion. D and E, Anteroposterior (D) and lateral (E) views of the basilar artery after endovascular stent deployment show restoration of normal vessel lumen. Although not obvious on these images, the superior margin of the stent covers the origins of both AICAs (arrows, D), which, however, continue to opacify normally. F, Nonsubtracted lateral oblique view of the posterior fossa shows the basilar artery metallic stent. The tip of the stent delivery catheter has been retracted inferiorly with the 0.014-inch exchange guidewire still in place.