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Objective:To evaluate the short-term efficacy and safety of Apollo stent in the treatment of symptomatic basilar artery stenosis.Methods:Patients with symptomatic basilar artery stenosis admitted to the Fourth Affiliated Hospital of China Medical University from January 2017 to May 2020 were selected and treated with Apollo stent implantation. The changes of clinical symptoms and the success rate of operation were evaluated. Postoperative complications included symptomatic intracranial hemorrhage, hyperperfusion, and new ischemic stroke, and follow-up results were evaluated 3 to 6 months later.Results:A total of 96 patients were included in this study, and all of them were confirmed by angiography to have severe basilar artery stenosis corresponding to the symptoms. Among them, 88 patients received stent implantation, with a success rate of 100%. Among the 88 patients, 86 received Apollo stent implantation, and 2 patients received self-Peng stent implantation. Among 86 patients with Apollo stent implantation, the lesions were located in the proximal segment in 73 cases (84.88%), in the middle segment in 10 cases (11.63%), and in the distal segment in 3 cases (3.49%). The degree of stenosis was (93.72±3.86)%, the length of stenosis was (8.50±2.65)mm, the residual stenosis rate was (1.76±4.87)%, and Mori type A lesions in 80 cases, type B lesions in 3 cases, and type C lesions in 3 cases. Among 86 patients with Apollo stent implantation, the incidence of perioperative neurological complications was 6.98%(6/86), including 1 case in the proximal part of the basilar artery (vascular rupture), 3 cases in the middle part of the basilar artery (perforating artery occlusion in 1 case, acute thrombosis artery occlusion in 2 cases), and 2 cases in the distal part (both acute vascular occlusion). Alteplase was injected into the microcatheter during the operation, and contact thrombolysis was performed. Immediately digital subtraction angiography (DSA) showed that the blood vessels were opened, and 1 case with neurological deficit was left. No hyperperfusion occurred in all patients. All patients were followed up for three months after operation. Among them, 58 patients had a good prognosis in the proximal segment of the basilar artery, 18 patients had a good prognosis in the middle segment, 4 patients had a good prognosis in the distal segment, and 6 patients had a bad prognosis (1 patient died). Postoperative stent restenosis occurred in 5 cases (5.81%), recurrent stroke in 3 cases (3.49%), and disabling stroke in 1 case (1.16%).Conclusions:Apollo stent is safe and effective in the treatment of symptomatic basilar artery stenosis, with good short-term prognosis, and long-term prognosis needs to be further studied.
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Objective To evaluate the correlation between cerebral blood flow perfusion and memory impairment in patients with severe stenosis of vertebral basilar artery (VBA).Methods 62 cases of patients with VBA stenosis diagnosed by digital subtraction angiography(DSA) in Beijing Tiantan Hospital from September 2016 to March 2017 were enrolled.Mental State Examination (MMSE),Clinical Memory Scale (CMS) test and CT perfusion(CTP) was performed.All patients were divided into memory normal group(n=24,including 1 excellent case,6 above normal cases,and 14 normal cases) and memory impairment group(n =38,including 18 below normal cases,12 periphery cases,8 impaired cases) according to CMS.The ratios of side-to-side period were compared between bilateral mesial temporal lobe and anterior circulation area.The relative time to peak (rTTP),relative mean transit time(rMTY),relative cerebral blood flow(rCBF) and relative cerebral blood volume (rCBV) were calculate.Results The incidence of CTP decompensation in the medial temporal lobe was higher than that in the patients with memory impairment(P＜0.05).The difference of rTTP and rMTT value between the two groups in the bilateral medial temporal lobes was statistically significant (rTFP:(1.131 ±0.037),(1.437±0.139),t=10.520,P＜ 0.05);rMTT:(1.081 ±0.059),(1.281 ±0.174),t=5.423,P＜0.05).Conclusion The patients with VBA severe stenosis are more likely to get memory impairment due to cerebral hypoperfusion.
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Objective To explore the efficacy,safety and short-term effects of endovascular therapy in the treatment of the symptomatic high-grade basilar artery stenosis.Methods Two hundred thirteen patients with the symptomatic high-grade basilar artery stenosis (＞90％) confirmed by MRA,CTA or DSA was treated by endovascular intervention,the changes of clinical symptoms,the success rate and short-term follow-up results was analyzed.Results Endovascular stent was successfully placed in 209 patients with symptomatic high-grade basilar artery stenosis and the success rate was 98.12％.The degree of vascular stenosis was significantly reduced after stenosis (Before vs After:93.70％±2.51％ vs 11.60％±3.90％).Eight patients had complications (3.76％) including 7 cases of ischemic stroke and 1 case of subarachnoid hemorrhage.The average follow-up duration was 18.70±3.80 months.Two hundred two patients underwent a second DSA and the mean vascular stenosis was (13.80％±4.20％).Five patients developed in-stent restenosis (ISR),of which one was symptomatic.Conclusion Endovascular therapy of the symptomatic high-grade basilar artery stenosis is safety and efficacy.The 1.5 years follow-up results reveal good patency rate and excellent prevention of posterior circulation ischemia.
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Objective To investigate the relation between microembolic signals (MES) and vertebral basilar artery ste?nosis in patients with brainstem infarction. Methods A total of 156 patients with acute brainstem infarction, who were de?termined the cerebral infarction lesion and vertebral basilar artery stenosis by cranial magnetic resonance imaging and CT an?giography, and were monitored by transcranial Doppler via occipital window of basilar arterial MES monitoring in 7 days of the onset, were divided into microembolus signal negative group (n=136) and positive group (n=20). The clinical data were compared between two groups. The differences of different degrees of stenosis were analyzed in two groups. The differences of different locations of stenosis in patients with vertebral basilar artery stenosis were analyzed in two groups. Logistic regres?sion analysis was used to analyse the factors affecting MES. Results There were no significant differences in age, gender, history of hypertension and diabetes mellitus between the two groups (P<0.05). There were significant differences in the dif?ferent degrees of stenosis between two groups, no or mild stenosis was found in MES-negative group and severe stenosis in MES-positive group (P<0.05). There were 70 cases with no vertebral basilar artery stenosis, 86 cases with mild, moderate and severe stenosis, in which 14 cases were MES-positive and 72 cases were negative. There were significant differences in different locations of stenosis between the two groups. The proportion of multiple infarctions was significantly higher in MES-positive group than that of MES-negative group (P<0.05). The intracranial vertebral basilar artery stenosis and 75%of ver?tebral basilar artery stenosis were the independent risk factors of MES-positive. Conclusion Severe stenosis of the verte?bral basilar artery is more vulnerable to occur MES of posterior circulation, leading to cerebral infarction. Microemboli may be the cause of multiple infarctions in patients with vertebral basilar artery stenosis.
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Objective To use high-resolution magnetic resonance imaging (HR-MRI) for studying the vascular remodeling and plaque characteristics of two types of basilar atherosclerotic infarction; branch occlusive disease (BOD) and nonBOD. Methods Thirty-two patients with symptomatic basilar artery stenosis were divided into BOD and non-BOD groups, with 18 patients in BOD group and 14 in non-BOD group. All the patients received 3. 0T HR-MRI enhancement scanning for the basilar artery wall. The wall thickness and plaque area of steno-occlusive basilar artery at the maximal stenosis were measured and analyzed, so as to assess the vascular remodeling and plaque characteristics. Results HR-MRI scanning showed that the stenosis of non-BOD group was more obvious than that of BOD group ([68. 9 ± 19. 1]% vs [43. 8 ± 18. 8]%, P = 0. 017). Compared with BOD group, positive remodeling wasmore frequently observed in non-BOD (57. 2% vs 16. 7%, P = 0. 036). The wall area index of BOD group was also significantly lower than that of non-BOD group (P<0. 001). Eccentric enhancement was the main form for the two types of basilar atherosclerotic infarction in study, and the plaque enhancements were not significantly different between BOD and non-BOD groups (P = 0. 196); however, the enhancement degree of BOD group was significantly milder than that of the non-BOD group ([39. 9 ± 23. 2]% vs [65. 3 ± 21. 1]%, P=0. 004). Conclusion BOD and non BOD have different vascular remodelings and plaque characteristics.
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Objective To assess the efficacy and feasibility of Wingspan stents for symptomatic atherosclerotic stenosis of the bas-ilar artery.Methods Clinical data of 40 patients with symptomatic atherosclerotic stenoses in the basilar artery were analyzed retro-spectively.The operative successful rate,the degree of stenosis,perioperative complications and the results of clinical and imaging follow-up were analyzed.Results The technical success rate was 95.35%.The rate of procedure-related complications during the perioperative period (30 days)was 20.0% (eight of 40 patients).There were two patients with no permanent neurological sequelae. Ipsilateral stroke or death occurred in six patients(1 5%).Thirty-six patients(92.3%)were available for a clinical follow up.The mean follow-up period was 36.3 months (range 12-75 months).Seventeen patients (47.2%)were available for follow-up imaging with DSA or CTA.The mean imaging follow-up period was 9.4 months (range 4-41 months).Symptomatic in-stent restenosis (ISR)was documented in two (1 1.76%)of these patients.Three ischemic events occurred during the follow-up period in 12 months.The adverse event rate was 8.33% at 1 year.Conclusion Wingspan stents for symptomatic atherosclerotic stenosis of the basilar artery was an effective and feasible technique,but we should carefully grasp the operation indications.
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Objective To investigate the sensitivity and specificity of transcranial Doppler (TCD) diagnosis for intracranial posterior circulation artery stenosis or occlusion.Methods Seventy-two cases of patients treated for posterior circulation intracranial artery stenosis or occlusion were chosen,TCD and CT angiography (CTA) tests were carried out and the results were compared and analyzed.Results Compared with CTA,the sensitivity for period of posterior circulation intracranial arteries by TCD was 82.50％,while specificity reached 94.64％.Positive predictive value attained 91.67％,while negative predictive value reached 88.33％ and the accuracy was 89.58％.Conclusions TCD diagnosis for period of posterior circulation intracranial arterial has high specificity,normal sensitivity,and the highest diagnosis accuracy for intracranial segment of vertebral artery.TCD can serve as early inspecting method for intracranial artery.
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The reversibility of basilar artery stenosis in neuro-Behcet's disease (NB) has been rarely reported. We report a patient with NB who developed brainstem infarction related to severe stenosis in basilar artery. Initial MRA showed severe stenosis in the basilar artery, which was improved on follow-up MRA after immunosuppressive treatment. This case shows that arterial stenosis in NB can be reversed with proper management.
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Humans , Basilar Artery , Brain Stem Infarctions , Constriction, Pathologic , Follow-Up Studies , Vertebrobasilar InsufficiencyABSTRACT
Patients with symptomatic stenosis of the basilar artery have a poor prognosis and the treatment options are limited. Surgical bypasses are technically difficult and there is no proven benefit. Percutaneous angioplasty shows significant complications because of dissection, restenosis secondary to elastic recoil and embolic phenomena. The medical treatment with aspirin and wafarin showed the annual risk of 20% for symptomatic basilar artery stenosis as repoted in WASID(Warfarin-Aspirin Symptomatic Intracranial Disease)study. We report a patient with symptomatic high grade stenosis of the basilar artery refractory to appropriate maximal medical therapy, in whom endovascular stenting was performed successfully without preliminary balloon angioplasty. Excellent angiographic result was achieved and there were no procedural and periprocedural complications. The patient was asymptomatic except preprocedural mild dysarthria and had no neurological symptoms during clinical follow-up of 2 months at outpatient department. Primary stenting of basilar artery stenosis may be an alternative to balloon angioplasty for patient with symptomatic lesions refractory to medical therapy or in whom anticoagulation is contraindicated.
Subject(s)
Humans , Angioplasty , Angioplasty, Balloon , Aspirin , Basilar Artery , Constriction, Pathologic , Dysarthria , Follow-Up Studies , Outpatients , Prognosis , Stents , Vertebrobasilar InsufficiencyABSTRACT
ObjectiveTo probe the short-term efficacy of endovascu lar stent-as sisted angioplasty for basilar artery stenosis.MethodsTwenty p atients with s ymptomatic basilar artery stenosis were treated by angioplasty using a balloon-e xpandable coronary stent.ResultsThe basilar artery caliber r eturned to norma l size in 12 cases and restored by more than 80% in the remaining 8 cases. No tr ansient ischemic attack (TIA), stroke, or other peri-operative complications rec urred. Follow-up angiography in 13 patients revealed no re-stenosis.Co nclusionsShort-term efficacy of endovascular stenting for basilar arte ry stenosis is promising.