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  • Endovascular treatment of patients with high-risk symptomatic intracranial vertebrobasilar stenoses: long - term outcomes

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Original research
Endovascular treatment of patients with high-risk symptomatic intracranial vertebrobasilar stenoses: long - term outcomes
  1. Tanja Djurdjevic1,2,
  2. André Cunha3,4,
  3. Ursula Schulz4,
  4. Dennis Briley4,5,
  5. Peter Rothwell4,
  6. Wilhelm Küker2,4
  1. 1 Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
  2. 2 Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3 Department of Neuroradiology, Centro Hospitalar Gaia/Espinho, Vila Nova de Gaia, Portugal
  4. 4 Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  5. 5 Neurology, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
  1. Correspondence to Dr Wilhelm Küker; wilhelm.kueker{at}ouh.nhs.uk

Abstract

Background and purpose We present the long-term outcome after endovascular treatment of symptomatic intracranial posterior circulation stenoses.

Methods 30 patients with symptomatic intracranial posterior circulation stenoses exceeding 70% underwent endovascular treatment between 2006 and 2012. Data regarding presentation, follow-up, procedure details, complications and imaging follow-up were reviewed. All surviving patients underwent a phone interview to establish their current Modified Ranking Scales (MRS).

Results Stenoses of the intracranial vertebral artery (24 patients) and basilar artery (6 patients) were treated with stents (10 patients), angioplasty alone (13 patients) or both (5 patients). Two procedures failed. One patient (3.3%) died after the procedure, two had stroke (6.6%) and one a subarachnoid haemorrhage without ensuing deficit. Two patients (6.7%) had asymptomatic complications (dissection and pseudoaneurysm). The median clinical follow-up time was 7 years. Of the 29 patients who survived the procedure, 6 died due to unrelated causes. Three patients (10%) had recurrent strokes and two (6.7%) a transient ischaemic attack in the posterior circulation. Two patients had subsequent middle cerebral artery strokes. Five (16.7%) patients had recurrent stenoses and three (10%) occlusions of the treated artery. Retreatment was performed in six patients, three (10%) with PTA and three (10%) with stenting. Current MRS scores were as follows: nine MRS 0, eight MRS 1, four MRS 2 and one MRS 4.

Conclusions Long-term follow-up after endovascular treatment of high-risk symptomatic intracranial posterior circulation stenoses shows few stroke recurrences. Treatment of intracranial vertebral artery stenosis may be beneficial in appropriately selected patients.

  • stent
  • angioplasty
  • atherosclerosis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2019-000230

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    Footnotes

    • Contributors TD: collection and analysis of data, drafting of the manuscript. AC: collection of data. US: collection and analysis of data, editing of the manuscript. DB: collection and analysis of data, editing of the manuscript. PR: analysis of data, editing of the manuscript. WK: design of the study, analysis of data, editing of the manuscript, guarantor of integrity of the study.

    • Funding WK is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC).

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Ethics approval The study was approved by the institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Patient consent for publication Not required.