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Tandem Intracranial Stent Deployment for Treatment of an Iatrogenic, Flow- limiting, Basilar Artery Dissection: Technical Case Report
- Source :
- Neurosurgery. 45:919-924
- Publication Year :
- 1999
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 1999.
-
Abstract
- Objective and importance Intimal dissection constitutes one of the complications associated with angioplasty of intracranial vessels. We present a case of iatrogenic dissection of the entire basilar artery, which was induced by angioplasty and stenting of symptomatic, focal, intracranial vertebral artery stenosis, and its successful treatment with tandem deployment of a downstream stent. Clinical presentation A 61-year-old, hypertensive, renal transplant recipient presented with orthostatic vertebrobasilar insufficiency that was refractory to medical management, including anticoagulation therapy. Angiography revealed an occluded right vertebral artery and focal, high-grade, left intracranial vertebral artery stenosis. Magnetic resonance imaging showed multiple posterior fossa infarctions. The left intracranial vertebral artery stenosis was successfully treated with primary stent deployment and balloon angioplasty, with symptom resolution. On postprocedure Day 2, the patient noted worsening right hemiparesis. Intervention Subsequent angiography revealed a flow-limiting, windsock-type, basilar artery dissection beginning at the distal end of the left vertebral artery stent and extending to the origin of the left posterior cerebral artery. A tandem stent was navigated intracranially and deployed past the first one, successfully sealing the dissection inflow zone and reconstituting normal flow to the top of the basilar artery. A clinical follow-up examination at 3 months revealed no further orthostatic symptoms and only mild residual right-sided weakness. Conclusion This is the first description of iatrogenic stent-induced dissection of the entire basilar artery that was successfully treated by inflow zone control via tandem intracranial stent deployment.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Iatrogenic Disease
Dissection (medical)
Posterior cerebral artery
Angioplasty
medicine.artery
Vertebrobasilar Insufficiency
medicine
Basilar artery
Humans
Vertebrobasilar insufficiency
medicine.diagnostic_test
business.industry
Stent
Intracranial Aneurysm
Middle Aged
medicine.disease
Cerebral Angiography
Surgery
Aortic Dissection
Basilar Artery
Retreatment
Angiography
Stents
Neurology (clinical)
Radiology
Tomography, X-Ray Computed
business
Angioplasty, Balloon
Cerebral angiography
Subjects
Details
- ISSN :
- 15244040 and 0148396X
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- Neurosurgery
- Accession number :
- edsair.doi.dedup.....f2b395faddc7e3fe7b47d73b90f7c1d6