Article Figures & Data
Figures
- Fig 1.
Case 9. A, A 6F guiding catheter placed at the right SA near the right VA ostium of 50% stenosis. B, Proximal end of the uninflated balloon anchored in the guiding catheter. The stent segment remains outside the catheter. C, The stent opening at first inflation resembles the shape of a dumbbell. D, The guiding catheter is pulled back to allow a second full inflation. E, Complete resolution of the stenosis.
- Fig 2.
Case 9. A, The guiding catheter is steered into the right extracranial VA with the aid of a partially re-inflated balloon within the stent at the VAO. B, The balloon was deflated as the catheter envelopes it within the VAO stent. C, The tip of the guiding catheter is placed at the distal V2 segment for stent placement of a short-segment stenosis (80%) in the BA. D, Resolution of the stenosis.
Tables
No. Age/Sex Risk Factors Symptoms Target Lesions Contralateral VA Concurrent Anterior Circulation ≥50% Stenosis mRS 1 70/M HT, CAD, CS TIA (vertigo) R-V1 L-V1 Oc L-intraICA 50% 1 R-V4 2 60/M HT, CS TIA (vertigo, diplopia, ataxia) R-V1, R-V4 L-V4 Oc R-ICA Oc 1 3 66/F HT Pontine infarct (vertigo, LOC) R-V1, BA L-V4 Oc L-M1 60% 0 4 79/M HT, CAD, CS TIA (vertigo) R-V1, BA L-V1 Oc R-ICA 55%, L-intraICA 60% 2 5 49/M HT, DL TIA (vertigo) L-V1, L-V4 R-V4 Oc No 0 6 60/M HT, CS TIA (vertigo) L-V1, BA R-V1 90% No 1 7 66/M HT TIA (vertigo) R-V1, R-V3, R-V4 L-V1 Oc R-intraICA 50% 2 8 74/M CS TIA (bilateral blindness) L-V1, L-V4 R-V1 Oc No 0 9 57/M HT, DL, DM, CS TIA (vertigo, L weakness) R-V1, BA L-V1 50% No 0 10 72/M HT, CS TIA (vertigo, R & L weakness) R-V1, R-V4 L-V4 Oc R-M1 50%, R-intraICA 60% 0 Note:—CAD indicates coronary artery disease; CS, cigarette smoking; DL, dyslipidemia; DM, diabetes mellitus; F, female; HT, hypertension; ICA, cervical internal carotid artery; intraICA, intracranial ICA; L, left; LOC, loss of consciousness; M, male; M1, first segment of middle cerebral artery; Oc, occlusion; R, right; V1, V3, V4, first, third, and fourth segments of the VA, respectively; TIA, transient ischemic attack; BA, basilar artery.
No.* Stenting Sequence GC into VA Stent Type†, Size (mm) Inflation Pressure (atm) Stenosis (%) Pre/Post DSA FU Stenosis (%/mo) mRS Last FU (score/mo) 1 R-V1→R-V4 Yes R-V1 Bio 4 × 15, R-V4 Bio 3.5 × 11 11, 10 60/20, 80/0 NA 1/59 2 R-V4→R-V1 Yes R-V1 Bio 4 × 11, R-V4 Cor 3 × 13 10, 8 50/0, 90/15 NA 0/52 3 R-V1→BA Yes R-V1 Cor 4 × 13, BA Bio 2 × 7 12, 7 30/0, 70/0 NA 0/50 4 RV1→BA No R-V1 Bio 4 × 15, BA failed 12 70/0, 95/95 NA 6/4 5 L-V4→L-V1 Yes L-V1 Fir 4 × 13, L-V4 Bio 3 × 28 14, 9 40/25, 70/15 10/6, 0/6 0/13 6 BA→L-V1 Yes L-V1 Bio 4 × 15, BA Apo 3 × 8 15, 9 60/20, 70/15 NA 0/20 7 R-V1→R-V4→R-V3 No R-V1 Tax 3.5 × 16, R-V4 Apo 2.5 × 13, R-V3 Apo 2.5 × 13 12, 16, 10 60/20, 70/10, 70/10 30/8, 30/8, 30/8 2/35 8 L-V1→L-V4 Yes L-V1 Exp 6 × 18, L-V4 Bio 3.5 × 15 10, 12 95/10, 95/20 5/7, 10/7 0/34 9 RV1→BA Yes R-V1 Exp 6 × 18 10, 8 50/0, 80/0 NA 0/30 10 R-V1→R-V4 Yes R-V1 Exp 5 × 19, R-V4 Bio 3 × 15 10, 10 70/0, 80/20 0/7, 0/7 0/18 Note:—mo indicates months; FU, follow-up; GC, guiding catheter; Pre, prestenting; Post, poststenting; VA, vertebral artery; DSA, digital subtraction angiography; mRS, modified Rankin scale; NA, not available.
* Case 2: general anesthesia, right brachial artery access, prestenting lumen diameter of the right VAO larger than guiding catheter. Case 4: tortuous right SA, excessive (3 mm) protrusion of VAO stent into the SA, failed to advance guiding catheter into the VA, failed to cross BA stenosis with microguidewire. Case 6: concurrent contralateral (right) VAO 90% stenosis stented first, prestenting lumen diameter of left VAO larger than guiding catheter. Case 7: excessive (5 mm) protrusion of VAO stent into the SA, failed to advance guiding catheter into VA but intracranial stents successfully delivered over microguidewire. Case 8: EPD (FilterWire, Boston Scientific, Natick, Mass) used during VAO stenting. Case 10: simultaneous stenting of right intracranial ICA.
† Apo indicates Apollo stent (MicroPort Medical, Shanghai, China); Bio, BiodivYsio (Abbott Laboratories, Abbott Park, Ill); Cor, Coroflex (Braun, Melsungen, Germany); Exp, Express (Boston Scientific, Natick, Mass); Fir, Firebird (MicroPort Medical); Tax, TAXUS Express (Boston Scientific,).
