American Journal of Roentgenology

2000

DOI: 10.2214/ajr.174.2.1740383

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Endovascular Stenting of Atherosclerotic Stenosis in a Basilar Artery After Unsuccessful Angioplasty

Gregory J. Joseph

¹

,

Jonas H. Goldstein²,

Harry J. Cloft³

et al.

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Discussion2

Experience With Intracranial Angioplasty and Stent Placement1

Introduction1

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Cited by 18 publications

(4 citation statements)

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“…Since late 1990's, clinical applications of coronary stent are started for treating intracranial arterial stenosis. In the previously reported 56 cases, morbidity due to brainstem infarction was 7% (four cases) and mortality was 9% (five cases) [1][2][3][4][5][6][7][8][9][10][11] .…”

Section: Discussionmentioning

confidence: 99%

“…Recent technical progress of the balloons and stents for coronary arteries enabled their insertion into torturous arteries, and several successful result of their application for intracranial artery has been reported [1][2][3][4][5][6][7][8][9][10][11] . The stent-assisted angioplasty for intracranial vessels, especially for the lesions at vertebral artery (VA) or the basilar artery (BA) will be one of effective treatment options at present.…”

Section: Introductionmentioning

confidence: 99%

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

¹

,

²

,

³

et al. 2006

Interv Neuroradiol

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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.

“…Since late 1990's, clinical applications of coronary stent are started for treating intracranial arterial stenosis. In the previously reported 56 cases, morbidity due to brainstem infarction was 7% (four cases) and mortality was 9% (five cases) [1][2][3][4][5][6][7][8][9][10][11] .…”

Section: Discussionmentioning

confidence: 99%

“…Recent technical progress of the balloons and stents for coronary arteries enabled their insertion into torturous arteries, and several successful result of their application for intracranial artery has been reported [1][2][3][4][5][6][7][8][9][10][11] . The stent-assisted angioplasty for intracranial vessels, especially for the lesions at vertebral artery (VA) or the basilar artery (BA) will be one of effective treatment options at present.…”

Section: Introductionmentioning

confidence: 99%

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

¹

,

²

,

³

et al. 2006

Interv Neuroradiol

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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.

“…Two reports have suggested that stent-assisted angioplasty may represent a viable therapeutic option for vertebral artery and basilar artery atheromatous stenoses [2,7]. The operators performed prestenting balloon angioplasty to predilate the lesions.…”

Section: Discussionmentioning

confidence: 99%

Primary Basilar Artery Stenting

¹

,

et al. 2000

American Journal of Roentgenology

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1367 e describe a patient in whom primary stenting without balloon predilation resolved a symptomatic atherosclerotic stenosis of the mid basilar artery for which long-standing medical therapy failed to resolve neurologic symptoms. At the 7month follow-up examination, the patient had no recurrent neurologic impairment, and follow-up angiograms showed total patency of the stented arterial segment without restenosis. Subject and MethodsA 42-year-old man was referred to our institution for angioplasty of a basilar artery stenosis. The stenosis was responsible for three successive ischemic attacks over a 10-month period. The second ischemic episode left the patient dysarthric and hemiparetic on the right side; however, he progressively regained complete motor power. MR images revealed an infarct on the left side of the pons and a mid basilar artery stenosis. Six months later, the patient, who had been undergoing treatment with warfarin, was readmitted for acute central vestibular syndrome. A cerebral angiogram revealed the previously documented basilar artery stenosis that was unchanged. The patient's clinical condition improved with IV heparin and acetylsalicylic acid (250 mg daily); then he was given warfarin and acetylsalicylic acid again. Three months later, the patient returned for angioplasty of the basilar artery stenosis.The procedure was performed with the patient under general anesthesia. On the frontal subtracted view, a 70% stenosis of the arterial lumen was noted over a 3.5-mm segment (Fig. 1A); on the lateral view, the vessel width was reduced by 60% over a 4-mm segment, according to the criteria of the North American Symptomatic Carotid Endarterectomy Trial (Fig. 1B). The stenosis appeared to be eccentric on the lateral projection. The stenosed arterial segment was located on the caudal aspect of an 11-mm-long atherosclerotic basilar segment. Both posterior communicating arteries were patent, providing blood flow to the posterior cerebral arteries territory. A small filling defect, corresponding to a nonobstructing clot, was seen in the P1 segment of the left posterior cerebral artery just above the origination of the superior cerebellar artery (Fig. 1A). After the insertion of a 6-French femoral sheath, 5000 U of heparin were injected IV followed by a continuous infusion of 3000 U/hr to obtain an activated clotting time at 200 sec. Two hundred fifty milligrams of acetylsalicylic acid and 10 mg of abxicimab (Reopro; Eli Lilly, Indianapolis, IN) were also given IV. A 6-French 90cm guiding catheter (Envoy; Cordis Endovascular, Miami Lakes, FL) was placed into the V2 segment of the left vertebral artery. A 0.014-inch guidewire (Transcend; Medit-tech/Boston Scientific, Natick, MA) was then navigated across the basilar artery stenosis, and the guidewire tip was secured into the left posterior cerebral artery (Fig. 1C). The balloon-expandable coronary stent (AVE GFX-2; Arterial Vascular Engineering-Medtronic, Santa Rosa, CA) had a diameter of 3.5 mm and a length of 18 mm; it was advanced over the guidewire t...

“…The incidence of acute dissection or vessel rupture and late restenosis prompted several investigators to attempt intracranial stent placement either primarily or following angioplasty. [21][22][23][24][25][26][27][28][29][30] A multicenter study, "Stenting in Symptomatic Atherosclerotic Lesions of Vertebral and Intracranial Arteries (SSYLVIA) trial," 31 evaluated the safety and efficacy of a new balloon catheter and stenting device (Neurolink, Guidant; Advanced Cardiovascular Inc) in 43 patients with symptomatic intracranial diseases and 18 with extracranial vertebral artery stenosis. Successful stent placement was achieved in 95% of the patients, with a 1-month postprocedure stroke rate of 7%.…”

Section: Experience With Intracranial Angioplasty and Stent Placementmentioning

confidence: 99%

Clinical and Angiographic Results of Dilatation Procedures for Symptomatic Intracranial Atherosclerotic Disease

¹

,

²

,

et al. 2005

Journal of Neuroimaging

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This single-center study demonstrates the feasibility and effectiveness (for secondary stroke prevention) of angioplasty and/or stent placement for treatment of ICAD.

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