Percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease: The experience of a single stroke centre

Abstract

Background Percutaneous transluminal angioplasty and stenting in acute stroke due to severe basilar artery stenosis or basilar artery occlusion remain a matter of debate. The higher risk of stroke recurrence in patients with vertebrobasilar stenosis compared to anterior circulation atherosclerotic disease creates high expectations concerning endovascular approaches. This study aims to review our experience with percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease. Methods Our prospective database from June 2014 until December 2020 was screened and patients with acutely symptomatic severe (>80%) basilar artery stenosis or acute basilar artery occlusion who underwent percutaneous transluminal angioplasty and stenting were analysed. Results Twenty-five patients included: 72% men (mean age 68.6 years), all with prior modified Rankin Scale <2. Twelve presented with acute basilar artery occlusion and were submitted to mechanical thrombectomy before percutaneous transluminal angioplasty and stenting, while the remaining had severe basilar artery stenosis. Successful stent placement was achieved in 22 (88%). Procedure-related complications included new small ischemic lesions (16%), basilar artery dissection (8%), vertebral artery dissection (12%) and death (12%). At 3 months post-percutaneous transluminal angioplasty and stenting, 10 out of 23 patients (43.5%) were independent (mRS ≤ 2) and six died. Fourteen patients underwent transcranial Doppler ultrasound 3 months post-percutaneous transluminal angioplasty and stenting: 12 showed residual stenosis, one significant stent restenosis and one presented stent occlusion. Conclusions Percutaneous transluminal angioplasty and stenting showed to be a technically feasible and reasonably safe procedure in selected patients. However, good clinical outcomes may be difficult to achieve as only 43.5% of the patients remained independent at 3 months. Randomized studies are needed to confirm the efficacy and safety outcomes of percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease.

Factors influencing the prognosis of acute basilar artery occlusion patients treated endovascularly: the impact of treatment time window and preoperative symptoms

“…This relatively low hemorrhage rate can be attributed to the fact that recanalization of the occluded vessel was achieved through direct aspiration in nearly half of the cases. Machado et al ( 24 ) reported a favorable prognosis rate of 43.5% at 90 days post-endovascular treatment of acute BAO. Similarly, in an international multicenter registry study that included 148 patients with BAO who underwent endovascular treatment, 79% achieved revascularization, and 34% achieved a favorable prognosis ( 4 ).…”

The Role of Transcranial-Color-Doppler in the Management of Basilar Artery Stenosis: Case Series and Systematic Review of Literature

“…The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) group compared the safety and efficacy of the two antithrombotic agents in a multicentric post hoc analysis of 68 patients with a stroke secondary to a 50-99% BAS [15]. They found that 23% of patients taking aspirin had a subsequent stroke in the same vascular territory as the stenotic artery compared with 10% for warfarin.…”

Rescue therapy after thrombectomy for large vessel occlusion due to underlying atherosclerosis: review of literature

“…There is currently no strong evidence to support emergent stenting after successful thrombectomy, as the data are scarce and limited to case series and cohort studies (26,27,(52)(53)(54)(55)(56). Li et al performed a comparative analysis of 184 consecutive patients with severe stenosis after thrombectomy, in which 64 patients underwent rescue angioplasty or stenting, and 120 patients were managed medically.…”