Pathological Result of Basilar Artery Stenosis Rapidly Progressed and Ruptured with Stent-assisted Angioplasty

Abstract

Intracranial artery angioplasty utilizing coronary stent is now widely tried as an effective alternative for treating intracranial artery stenosis, and several successful result of stent-assisted angioplasty for intracranial artery were reported. Authors experienced a case of the basilar artery stenosis, in which re-stenosis progressed rapidly after simple balloon angioplasty and resulted in vessel rupture during stent-assisted angioplasty. Pathological result achieved by autopsy showed vessel wall disruption at the stent and multiple interruptions and defect of elastic laminar.

Figure 1

MRI (Left) and MRA (Right) obtained the day of the initial episode. MRI shows small brainstem infarction (arrow) and MRA suggests severe basilar artery trunk stenosis. (arrowhead).

Figure 2

Angiogram obtained two weeks after the initial episode. Right vertebral angiogram (left) showing severe stenosis at the basilar artery (arrows). Right carotid angiogram (right) shows poor collateral circulation to PCA via posterior communicating artery (arrowheads).

Figure 3

Left vertebral angiogram after angioplasty shows that the stenotic basilar artery is successfully dilated

Figure 4

Angiograms obtained after stent placement. Angiogram just after angioplasty shows massive extravasation form lower part of the lesion (left) and left vertebral angiogram after haemostasis shows good dilation of the lesion (middle, right).

Figure 5

Cross sectional specimen of the ruputured part shows complete disconnection of the muscular layer (arrows) and disrupted part is covered only with fibrin. Multiple disruptions (arrowheads) of the elastic lamina are observed especially at the margin of the intimal hypertrophy.

Figure 6

Cross sectional image of basilar artery proximally to the stent (left) and distal end of the stent (right) obtained from autopsied specimen shows hypertrophic elastic lamina with duplication (arrows).