Introduction Occlusion of the basilar artery (BA) has a poor prognosis. We evaluated technical considerations and complications associated with reopening subacute to chronically occluded BAs.
Methods Duration of BA occlusion before revascularization, symptoms and medical management before treatment, and postprocedural antiplatelet regimen and anticoagulation protocols of 10 patients were analyzed. All patients underwent attempted Gateway angioplasty followed by Wingspan stenting (Boston Scientific, Fremont, California, USA).
Results 10 patients, including seven men and three women, were treated from 2004 to the present. They ranged in age from 29 to 80 years with a mean of 62. The median time between onset of symptoms to treatment ranged from 4 to 150 days (mean 50 days). Recanalization was successful in 8/10 patients. Immediately following the procedure, seven patients were either improved or stable, and three were worse. Of these three, two died of procedure related complications and one suffered a mild brainstem stroke from which she has made a substantial recovery. A third patient died in a delayed fashion of unrelated causes. Three subacute complications occurred. These included: one acute thrombosis of the stent requiring emergent repeat angioplasty, one symptomatic basilar dissection requiring placement of a second stent 1 week after the original procedure and one mild recurrent stroke after delayed stent occlusion. Of the seven surviving patients, five are improved or stable. The other two patients are mentioned above and suffered a mild brainstem procedurally related stroke and the other a delayed stroke as a result of re-occlusion.
Conclusion With current endovascular techniques, recanalization of the subacute and chronically occluded basilar artery is feasible. The procedure carries substantial risks and should be reserved for patients with medically refractory symptoms. Careful postprocedural medical management and radiographic follow-up are warranted do prevent in-stent restenosis.
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Competing interests FA—Micrus, EV3, Advanced Medical Devices Inc.