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. 2023 Nov;18(3):166-171.
doi: 10.5469/neuroint.2023.00437. Epub 2023 Oct 19.

Endovascular Treatment of Symptomatic Basilar Artery Stenosis

Jae Ho Kim  1 , Kwang-Chun Cho  2 , Taemin Kim  3 , Sang Woo Ha  1 , Sang Hyun Suh  4   5
Affiliations

Endovascular Treatment of Symptomatic Basilar Artery Stenosis

Jae Ho Kim et al. Neurointervention. 2023 Nov.

Abstract

Purpose: While symptomatic basilar artery (BA) stenosis is associated with a higher risk of recurrent stroke or death, there is no consensus on the management of these patients who are refractory to antiplatelet therapy. This study retrospectively assesses the outcomes of endovascular treatment (EVT) for symptomatic BA stenosis.

Materials and methods: We conducted a retrospective review of patients with symptomatic BA stenosis who underwent EVT, including angioplasty or stenting, from 2006 to 2018. A total of 15 patients, who experienced transient ischemic attacks or strokes despite dual antiplatelet therapy, were included. EVT was performed under local anesthesia after pretreatment with antiplatelet medications. Angiographic follow-up was performed at 12 and 24 months post-EVT. Clinical outcomes were evaluated using the modified Rankin Scale (mRS).

Results: EVT was successfully completed in all patients. Peri/post-procedural complications occurred in 33% of cases, including in-stent thrombosis, intracranial hemorrhage, and pontine infarction. At long-term follow-up (mean 98.5±80.5 months), 73.3% of patients achieved a favorable functional outcome (mRS≤2) without disability or mortality. Patients with unfavorable outcomes had previous infarcts, with 2 experiencing new pontine infarctions after stenting.

Conclusion: This study suggests that EVT, including angioplasty and stenting, may offer promise as a treatment option for symptomatic BA stenosis refractory to medical therapy. However, the procedure carries a notable risk of complications, especially in patients with severe stenosis and previous infarcts. Careful patient selection, based on clinical and radiological criteria, is crucial.

Keywords: Angioplasty; Atherosclerosis; Basilar artery; Stenosis; Stents.

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Conflict of interest statement

Conflicts of Interest

SHS has been the Editor-in-Chief of the Neurointervention since 2023; however, SHS has not been involved in the peer reviewer selection, evaluation, or decision process of this article. No potential conflict of interest relevant to this article was reported. No other authors have any conflict of interest to disclose.

Figures

Fig. 1.
Fig. 1.
Symptomatic stenosis of the mid-basilar artery. (A) Prestenting, (B) post-stenting, and (C) 1 year follow-up angiographic images.
Fig. 2.
Fig. 2.
A complicated case after stenting. (A) Presenting and (B) post-stenting images showed non-visualization of the right-sided perforators after stenting. (C) Diffusion weighted image showed newly developed infarction in the right pons.
See this image and copyright information in PMC

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