Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: An initial experience

Peter A. Rasmussen, John Perl, John D. Barr, Georges Z. Markarian, Irene Katzan, Cathy Sila, Derk Krieger, Anthony J. Furlan, Thomas J. Masaryk

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

Object. Patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experience with eight patients in whom medically refractory TIAs secondary to intracranial posterior circulation atherosclerotic occlusive lesions were treated with stent-assisted angioplasty. Methods. Eight patients (six men), ranging in age from 43 to 77 years, experienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed severe distal vertebral (four patients), proximal basilar (one patient), or proximal and midbasilar stenoses (three patients). Aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, and this regimen was maintained by the patients on discharge. Patients underwent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all patients before and after the procedure. The VBAs in all patients were successfully revascularized with 7 to 28% residual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid hemorrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are asymptomatic up to 8 months postoperatively. Conclusions. Although primary intracranial VBA angioplasty with stent insertion is technically feasible, complications associated with the procedure can be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into catastrophic VBA insufficiency.

Original languageEnglish (US)
Pages (from-to)771-778
Number of pages8
JournalJournal of Neurosurgery
Volume92
Issue number5
StatePublished - May 2000

Fingerprint

Intracranial Arteriosclerosis
Angioplasty
Stents
Arteries
Vertebrobasilar Insufficiency
clopidogrel
Transient Ischemic Attack
Pathologic Constriction
Groin
Patient Discharge
Platelet Aggregation Inhibitors
Brain Diseases

Keywords

  • Angioplasty
  • Atherosclerosis
  • Interventional neuroradiology
  • Vertebrobasilar artery stent

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Rasmussen, P. A., Perl, J., Barr, J. D., Markarian, G. Z., Katzan, I., Sila, C., ... Masaryk, T. J. (2000). Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: An initial experience. Journal of Neurosurgery, 92(5), 771-778.

Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis : An initial experience. / Rasmussen, Peter A.; Perl, John; Barr, John D.; Markarian, Georges Z.; Katzan, Irene; Sila, Cathy; Krieger, Derk; Furlan, Anthony J.; Masaryk, Thomas J.

In: Journal of Neurosurgery, Vol. 92, No. 5, 05.2000, p. 771-778.

Research output: Contribution to journalArticle

Rasmussen, PA, Perl, J, Barr, JD, Markarian, GZ, Katzan, I, Sila, C, Krieger, D, Furlan, AJ & Masaryk, TJ 2000, 'Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: An initial experience', Journal of Neurosurgery, vol. 92, no. 5, pp. 771-778.
Rasmussen PA, Perl J, Barr JD, Markarian GZ, Katzan I, Sila C et al. Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: An initial experience. Journal of Neurosurgery. 2000 May;92(5):771-778.
Rasmussen, Peter A. ; Perl, John ; Barr, John D. ; Markarian, Georges Z. ; Katzan, Irene ; Sila, Cathy ; Krieger, Derk ; Furlan, Anthony J. ; Masaryk, Thomas J. / Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis : An initial experience. In: Journal of Neurosurgery. 2000 ; Vol. 92, No. 5. pp. 771-778.
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abstract = "Object. Patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30{\%} of patients. The authors report their initial experience with eight patients in whom medically refractory TIAs secondary to intracranial posterior circulation atherosclerotic occlusive lesions were treated with stent-assisted angioplasty. Methods. Eight patients (six men), ranging in age from 43 to 77 years, experienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed severe distal vertebral (four patients), proximal basilar (one patient), or proximal and midbasilar stenoses (three patients). Aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, and this regimen was maintained by the patients on discharge. Patients underwent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all patients before and after the procedure. The VBAs in all patients were successfully revascularized with 7 to 28{\%} residual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid hemorrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are asymptomatic up to 8 months postoperatively. Conclusions. Although primary intracranial VBA angioplasty with stent insertion is technically feasible, complications associated with the procedure can be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into catastrophic VBA insufficiency.",
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T2 - An initial experience

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AU - Katzan, Irene

AU - Sila, Cathy

AU - Krieger, Derk

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AU - Masaryk, Thomas J.

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N2 - Object. Patients with intracranial vertebrobasilar artery (VBA) atherosclerotic occlusive disease have few therapeutic options. Unfortunately, VBA transient ischemic attacks (TIAs) herald a lethal or devastating event within 5 years in 25 to 30% of patients. The authors report their initial experience with eight patients in whom medically refractory TIAs secondary to intracranial posterior circulation atherosclerotic occlusive lesions were treated with stent-assisted angioplasty. Methods. Eight patients (six men), ranging in age from 43 to 77 years, experienced signs and symptoms of VBA insufficiency despite combination therapy with warfarin and antiplatelet agents. Angiographic studies revealed severe distal vertebral (four patients), proximal basilar (one patient), or proximal and midbasilar stenoses (three patients). Aspirin and clopidogrel were administered for 3 days before primary angioplasty and stent placement, and this regimen was maintained by the patients on discharge. Patients underwent heparinization during the procedure and were given a bolus and 12-hour infusion of abciximab. A neurologist specializing in stroke evaluated all patients before and after the procedure. The VBAs in all patients were successfully revascularized with 7 to 28% residual stenosis. Six patients experienced no neurological complications. One patient died the evening of the procedure due to a massive subarachnoid hemorrhage. Two patients had groin hematomas, one developed congestive heart failure, and one had transient encephalopathy. All surviving patients are asymptomatic up to 8 months postoperatively. Conclusions. Although primary intracranial VBA angioplasty with stent insertion is technically feasible, complications associated with the procedure can be life threatening. As experience is gained with this procedure, it may be offered routinely as an alternative therapy to patients with medically refractory posterior circulation occlusive disease that may develop into catastrophic VBA insufficiency.

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