Neurointervention.  2023 Nov;18(3):166-171. 10.5469/neuroint.2023.00437.

Endovascular Treatment of Symptomatic Basilar Artery Stenosis

• Kim JH
• Cho KC
• Kim T
• Ha SW
• Suh SH

• KMID: 2547278
• DOI: http://doi.org/10.5469/neuroint.2023.00437

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.

Keyword

Basilar artery; Atherosclerosis; Stenosis; Stents; Angioplasty

Figure

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  Fig. 1. Symptomatic stenosis of the mid-basilar artery. (A) Prestenting, (B) post-stenting, and (C) 1 year follow-up angiographic images.

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  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.

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