| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2000;31:95.)
© 2000 American Heart Association, Inc.
Original Contributions |
Elective Stenting of Symptomatic Basilar Artery Stenosis
From the Departments of Neurology (C.R.G., J.B.T., R.T., M.S.C.), Medicine (Cardiology) (V.K.M., M.W.L.), and Radiology (V.R.W.), University of Alabama at Birmingham.
Correspondence to Camilo R. Gomez, MD, Comprehensive Stroke Center, 1202 Jefferson Tower, 625 S 19th St, Birmingham, AL 35294. E-mail crgomez{at}uab.edu
Background and Purpose—Percutaneous angioplasty of the intracranial arteries still carries the risk of dissection, with acute closure and embolization. Stenting has been shown to improve the safety and durability of angioplasty in every circulatory bed in which it has been applied. However, stenting of the intracranial arteries has been limited by the availability of stents that can be reliably deployed intracranially.
Methods—Twelve patients underwent elective stenting of the basilar artery after episodes of vertebrobasilar ischemia. In all patients, either medical therapy had failed or the patient had a contraindication for long-term anticoagulation. Information from independent neurological examinations, quantitative angiography, and clinical follow-up was collected. Differences between pretreatment and posttreatment degree of stenoses were subjected to 1-way ANOVA for repeated measures.
Results—There were 10 men and 2 women, all white, aged 40 to 82 years (mean age, 62.6 years). Stent placement was successful in all patients, leading to statistically significant changes in the degree of stenosis, from 71.4% (range, 53% to 90%) to 10.3% (range, 0% to 36%) (P<0.0001). There were no deaths, stent thromboses, perforations, ruptures, or myocardial infarctions. Clinical follow-up was available for 0.5 to 16 months (mean, 5.9 months). One patient had nonspecific symptoms, and another had a transient ischemic attack. All other patients remained asymptomatic.
Conclusions—Elective stenting of the basilar artery is feasible, with minimal risk to the patient. Its impact on long-term stroke prevention and its durability are unknown and will require further study.
Key Words: angioplasty • basilar artery • stenosis • stents
This article has been cited by other articles:
 |
|
 |
|
  F. Nahab, M. J. Lynn, S. E. Kasner, M. J. Alexander, R. Klucznik, O. O. Zaidat, J. Chaloupka, H. Lutsep, S. Barnwell, M. Mawad, et al. Risk factors associated with major cerebrovascular complications after intracranial stenting Neurology, June 9, 2009; 72(23): 2014 - 2019. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Groschel, S. Schnaudigel, S. M. Pilgram, K. Wasser, and A. Kastrup A Systematic Review on Outcome After Stenting for Intracranial Atherosclerosis Stroke, May 1, 2009; 40(5): e340 - e347. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. C. Schumacher, P. M. Meyers, R. T. Higashida, C. P. Derdeyn, S. D. Lavine, G. M. Nesbit, D. Sacks, P. Rasmussen, and L. R. Wechsler Reporting Standards for Angioplasty and Stent-Assisted Angioplasty for Intracranial Atherosclerosis Stroke, May 1, 2009; 40(5): e348 - e365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Siddiq, G. Vazquez, M. Z. Memon, M. F. K. Suri, R. A. Taylor, J. C. Wojak, J. C. Chaloupka, and A. I. Qureshi Comparison of Primary Angioplasty With Stent Placement for Treating Symptomatic Intracranial Atherosclerotic Diseases: A Multicenter Study Stroke, September 1, 2008; 39(9): 2505 - 2510. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Imai, T. Mori, H. Izumoto, T. Kunieda, N. Takabatake, S. Yamamoto, and M. Watanabe Transluminal Angioplasty and Stenting for Intracranial Vertebrobasilar Occlusive Lesions in Acute Stroke Patients AJNR Am. J. Neuroradiol., April 1, 2008; 29(4): 773 - 780. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D.C. Suh, J.K. Kim, J.W. Choi, B.S. Choi, H.W. Pyun, Y.J. Choi, M.-H. Kim, H.R. Yang, H.I. Ha, S.J. Kim, et al. Intracranial Stenting of Severe Symptomatic Intracranial Stenosis: Results of 100 Consecutive Patients AJNR Am. J. Neuroradiol., April 1, 2008; 29(4): 781 - 785. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Jiang, T. Srivastava, F. Gao, B. Du, K. H. Dong, and X. T. Xu Perforator stroke after elective stenting of symptomatic intracranial stenosis Neurology, June 27, 2006; 66(12): 1868 - 1872. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Kasner, M. I. Chimowitz, M. J. Lynn, H. Howlett-Smith, B. J. Stern, V. S. Hertzberg, M. R. Frankel, S. R. Levine, S. Chaturvedi, C. G. Benesch, et al. Predictors of Ischemic Stroke in the Territory of a Symptomatic Intracranial Arterial Stenosis Circulation, January 31, 2006; 113(4): 555 - 563. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. O. Zaidat, T. P. Smith, M. J. Alexander, W. Yu, W.S. Smith, V. Singh, N.U. Ko, S.P. Cullen, C.F. Dowd, V.V. Halbach, et al. Long-term outcome of endovascular stenting for symptomatic basilar artery stenosis Neurology, October 25, 2005; 65(8): 1340 - 1341. [Full Text] [PDF]
|
|
|
|
|
|
Intracranial Angioplasty & Stenting for Cerebral Atherosclerosis: A Position Statement of the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, and the American Society of Neuroradiology AJNR Am. J. Neuroradiol., October 1, 2005; 26(9): 2323 - 2327. [Full Text] [PDF]
|
|
|
|
|
|
D. J. Kim, B. H. Lee, D. I. Kim, W. H. Shim, P. Jeon, and T. H. Lee Stent-Assisted Angioplasty of Symptomatic Intracranial Vertebrobasilar Artery Stenosis: Feasibility and Follow-up Results AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1381 - 1388. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. E. Mayer, G. F. Hamann, G. Schulte-Altedorneburg, and H. Bruckmann Treatment of Vertebrobasilar Occlusion by Using a Coronary Waterjet Thrombectomy Device: A Pilot Study AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1389 - 1394. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Amin-Hanjani, X. Du, M. Zhao, K. Walsh, T. W. Malisch, and F. T. Charbel Use of Quantitative Magnetic Resonance Angiography to Stratify Stroke Risk in Symptomatic Vertebrobasilar Disease Stroke, June 1, 2005; 36(6): 1140 - 1145. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Bash, J. P. Villablanca, R. Jahan, G. Duckwiler, M. Tillis, C. Kidwell, J. Saver, and J. Sayre Intracranial Vascular Stenosis and Occlusive Disease: Evaluation with CT Angiography, MR Angiography, and Digital Subtraction Angiography AJNR Am. J. Neuroradiol., May 1, 2005; 26(5): 1012 - 1021. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Yu, W. S. Smith, V. Singh, N. U. Ko, S. P. Cullen, C. F. Dowd, V. V. Halbach, and R. T. Higashida Long-term outcome of endovascular stenting for symptomatic basilar artery stenosis Neurology, March 22, 2005; 64(6): 1055 - 1057. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. P. Marks, M. L. Marcellus, H. M. Do, P. K. Schraedley-Desmond, G. K. Steinberg, D. C. Tong, and G. W. Albers Intracranial Angioplasty without Stenting for Symptomatic Atherosclerotic Stenosis: Long-Term Follow-up AJNR Am. J. Neuroradiol., March 1, 2005; 26(3): 525 - 530. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Masuo, T. Terada, G. Walker, M. Tsuura, K. Nakai, and T. Itakura Patency of Perforating Arteries after Stent Placement? A Study Using an In Vivo Experimental Atherosclerosis-Induced Model AJNR Am. J. Neuroradiol., March 1, 2005; 26(3): 543 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Tsumoto, T. Terada, M. Tsuura, H. Matsumoto, O. Masuo, H. Yamaga, and T. Itakura Diffusion-Weighted Imaging Abnormalities after Percutaneous Transluminal Angioplasty and Stenting for Intracranial Atherosclerotic Disease AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 385 - 389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Molina, M. Ribo, F. Romero, and J. Alvarez-Sabin Hemodynamic changes in the basilar artery following stenting Neurology, April 27, 2004; 62(8): 1398 - 1398. [Full Text] [PDF]
|
|
|
|
 |
|
 R. du Mesnil de Rochemont, B. Turowski, M. Buchkremer, M. Sitzer, F. E. Zanella, and J. Berkefeld Recurrent Symptomatic High-Grade Intracranial Stenoses: Safety and Efficacy of Undersized Stents-- Initial Experience Radiology, April 1, 2004; 231(1): 45 - 49. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Gupta, H.C. Schumacher, S. Mangla, P.M. Meyers, H. Duong, A.G. Khandji, R.S. Marshall, J.P. Mohr, and J. Pile-Spellman Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis Neurology, December 23, 2003; 61(12): 1729 - 1735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Chaturvedi and R. Fessler Angioplasty and stenting for stroke prevention: Good questions that need answers Neurology, September 10, 2002; 59(5): 664 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Masuo, T. Terada, G. Walker, M. Tsuura, H. Matsumoto, K. Tohya, M. Kimura, K. Nakai, and T. Itakura Study of the Patency of Small Arterial Branches after Stent Placement with an Experimental in Vivo Model AJNR Am. J. Neuroradiol., April 1, 2002; 23(4): 706 - 710. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Lylyk, J. E. Cohen, R. Ceratto, A. Ferrario, and C. Miranda Angioplasty and Stent Placement in Intracranial Atherosclerotic Stenoses and Dissections AJNR Am. J. Neuroradiol., March 1, 2002; 23(3): 430 - 436. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. R. Gomez and S. C. Orr Angioplasty and Stenting for Primary Treatment of Intracranial Arterial Stenoses Arch Neurol, October 1, 2001; 58(10): 1687 - 1690. [Full Text] [PDF]
|
|
|
|
|
|
M. I. Chimowitz Angioplasty or Stenting Is Not Appropriate as First-Line Treatment of Intracranial Stenosis Arch Neurol, October 1, 2001; 58(10): 1690 - 1692. [Full Text] [PDF]
|
|
|
|
|
|
C. C. Phatouros, J. E. Lefler, R. T. Higashida, P. M. Meyers, A. M. Malek, C. F. Dowd, and V. V. Halbach Primary Stenting for High-grade Basilar Artery Stenosis AJNR Am. J. Neuroradiol., October 1, 2000; 21(9): 1744 - 1749. [Abstract] [Full Text]
|
|
|
|
|
|
H. L. Lutsep and W. M. Clark Association of intracranial stenosis with cortical symptoms or signs Neurology, September 12, 2000; 55(5): 716 - 718. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. C. Nahser, H. Henkes, W. Weber, E. Berg-Dammer, T. A. Yousry, and D. Kuhne Intracranial Vertebrobasilar Stenosis:Angioplasty and Follow-up AJNR Am. J. Neuroradiol., July 1, 2000; 21(7): 1293 - 1301. [Abstract] [Full Text] [PDF]
|
|