Primary Basilar Artery Stenting

Abstract

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...

Evaluation of the Pontine Perforators of the Basilar Artery Using Digital Subtraction Angiography in High Resolution and 3D Rotation Technique

“…1,2 Because of the small diameter of these side branches of 383 m, visualization by different means of angiographic imaging like CT-or MR-based angiography is difficult and uncertain. 3 High-resolution DSA images with 2k matrix (detector format 32 ϫ 32 cm; image matrix 2480 ϫ 1920 pixels) and especially flat detector CT with pixel sizes of 308 m ϫ 308 m (2 ϫ 2 binning), using a reconstructed section thickness of 0.1 mm and highcontrast resolution of CT and 3D reconstructions, provide a new basis to display these small vessels on recent flat detector neuroangiography systems.…”