Primary Angioplasty without Stenting for Symptomatic, High-Grade Intracranial Stenosis with Poor Circulation

A 65-year-old man with symptomatic severe basilar artery stenosis, refractory to medical therapy (case 1). A, Angiogram of the left vertebral artery reveals severe stenosis of the vertebrobasilar junction (angiographic characteristic: TICI 1). B, High-resolution MR imaging confirms the atherosclerotic lesion and shows the eccentric plaque located at the vertebrobasilar junction and the surface of the plaque enhancement. C, Immediate angiogram after primary angioplasty with a 1.5- to 9-mm Gateway balloon; antegrade flow improved and reached TICI grade 2b. D, Angiogram of the left vertebral artery at 14-month follow-up reveals no severe restenosis, and antegrade flow reaches TICI grade 3.