症候性頭蓋内椎骨脳底動脈狭窄に対する血管内治療  [in Japanese] Endovascular Treatment of Symptomatic Intracranial Vertebrobasilar Artery Stenosis  [in Japanese]

Patients who have symptomatic, medically refractory, vertebrobasilar artery stenosis have a high risk of stroke. The benefits of vascular reconstruction surgery and balloon angioplasty for these lesions are limited, and these treatments are associated with considerable complications. Recently stent placement in the intracranial arteries became available and is expected to improve the results of endovascular treatments. We review our experience with endovascular treatment for symptomatic intracranial vertebrobasilar artery stenosis. Forty patients with intracranial vertebrobasilar artery stenosis were treated with endovascular surgery. Indication of the endovascular surgery was medically refractory symptomatic patients with over 60% angiographical stenosis. Balloon angioplasty was firstly performed in all patients. Stenting was performed only in cases with insufficient dilatation, dissection or restenosis after balloon angioplasty. Successful dilatation was obtained in all cases. Twelve patients underwent stenting in initial treatments. The stenosis rate reduced to 25.2% after balloon angioplasty and 16.1% after stenting. No neurological complications occurred after procedure. The restenosis rates after treatments were 25.9% after balloon angioplasty and 23.5% after stenting. During the follow-up period, only 1 patient developed stroke of posterior circulation. Endovascular surgery for symptomatic vertebrobasilar artery stenosis has become more feasible and safer after the introduction of stenting. Prevention of restenosis is the next problem to be solved.