What is the role of angioplasty in the treatment of vertebrobasilar stroke?

Updated: Mar 03, 2020
  • Author: Vladimir Kaye, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Angioplasty has been performed to treat patients with atherosclerotic basilar artery stenosis. The use of angioplasty is based on the tendency of thrombosis to occur in stenosed arterial segments. Reports describe angioplasty performed in patients with acute vertebrobasilar occlusion, as well as electively. The published case series report a morbidity rate of 0-16% and a mortality rate of up to 33%; however, the role of angioplasty in the treatment of vertebrobasilar occlusion is not well defined.

A study by Hatano and Tsukahara indicated that endovascular treatment with balloon angioplasty can be safe and effective in selected patients with intracranial vertebrobasilar artery stenosis. In the report, 44 patients with the condition who fit certain criteria—ie, those who were medically refractory and symptomatic, with lesions below 15 mm in length and, as revealed on angiography, greater than 60% stenosis—underwent balloon angioplasty under local anesthesia. Stent placement was also used, if dilation was insufficient or if dissection or restenosis occurred. By 30 days after treatment, the stroke and death rate was just 2.3%. [38]

Within six months following treatment, restenosis had occurred in nine patients, with four of them being symptomatic, but subsequent balloon angioplasty or stenting successfully relieved the problem in the symptomatic patients. Hatano and Tsukahara cautioned that although their study indicates that endovascular therapy can effectively treat intracranial vertebrobasilar artery stenosis, clinical and radiologic follow-up is necessary owing to the possibility of restenosis. [38]


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