Article Figures & Data
Figures
- Fig 1.
Representative case of multistaged balloon inflation technique in a patient with left distal vertebral artery stenosis.
A, Pretreament angiogram shows a severely stenosed left distal vertebral artery at the site of posterior inferior cerebellar artery.
B, Angiogram shows the stent placed at the targeted lesion site; slow subnominal inflation (5 atm in this case) of the balloon was performed, with special consideration given to preventing “dog boning” of the proximal and distal ends of the balloon. Angiogram (not shown) was obtained to confirm the absence of a gap at the distal end of the stent.
C, Angiogram shows the balloon is carefully retrieved, with the proximal balloon marker (dotted arrow) placed outside the struts of the proximal end of the stent (solid arrow).
D, The balloon was slowly inflated to or above the nominal pressure, with special consideration given to avoiding any gap in the middle and proximal aspects of the stents. Repeat inflations were performed if any gap was visualized on the angiogram.
E, Final angiogram shows a well-positioned stent without gaps.
- Fig 2.
Case 8. A 55-year-old man with transient ischemic attack at presentation.
A, Initial left vertebral artery angiogram shows 95% stenosis of the intracranial vertebral artery.
B, Angiogram shows that the distal vertebral artery is straightened because of the stent-mounted catheter, and the lesion site is displaced more cranially (arrow). Primary stent deployment was attempted with a S660 2.5/9 stent; however, the distal end of the stent could not pass through the lesion site. Stent catheter was not retrieved because of concerns for acute thrombus formation. Notice the compromised flow in the basilar artery due to the trapped stent catheter.
C, Magnified angiographic view. After deployment of the initial stent (solid arrows) and additional careful angioplasty, a second stent-mounted catheter (dotted arrows) was navigated through the initial stent.
D, Magnified angiographic view. The second stent (dotted arrows) was deployed partially overlapping the initial stent (solid arrows) and covering the distal aspect of the lesion.
E, Final angiogram shows no residual stenosis.
F, Seventeen-month follow-up angiogram shows the patent stent site without significant restenosis.
Tables
Case No. Sex Age Lesion Location Comorbidities Mori Lesion Type Stenosis (%) Predilatation (mm) Stent (mm) Complication Before After 1 F 58 BA H B 59 0 Maxxum 2.75/12 S660 2.75/18 Acute in-stent thrombosis* 2 F 63 BA H, D, L A 65 5 Jo flex 4/16 IVA, Lt C 60 0 S670 3/24 3 F 65 IVA, Lt H B 62 10 S670 3.5/18 4 M 60 BA H C 82 0 Maverick 2/12 Cypher 2.5/13 Dizziness, ataxia† 5 M 51 IVA, Rt H, D, S C 95 0 Maestro 1.5/20 Jo flex 2.5/23 6 M 70 IVA, Lt H, D, S, C A 90 0 S670 4/18 7 F 66 IVA, Lt H, D B 70 0 Jo flex 4/23 8 M 55 IVA, Lt H, D, L, S, C A 95 0 S660 2.5/9, 2.5/12‡ 9 M 70 IVA, Rt H, C C 70 0 Jo bare 5/17 10 M 74 IVA, Rt H, D, S, M B 69 0 Ranger 2.5/20 AVE 3.5/12 11 F 60 BA H C 95 0 S670 3/18 12 M 69 BA H B 90 0 Jo flex 3.5/16 13 M 62 IVA, Lt H, L B 74 0 Larus 2.5/10 Jo Stent 3.0/12 14 F 65 BA H C 90 5 S670 3.5/24 IVA, Lt B 60 0 S670 4/24 15 F 76 IVA, Lt H, D, L, S C 80 0 S660 2.5/15,S670 3/19§ 16 M 68 IVA, Lt H, S, C C 50 5 S7 4/30 17 M 60 IVA, Lt H, L, S C 90 0 Maestro 1.5/20 Jo flex 3/19 Note.—IVA indicates intracranial vertebral artery; BA, basilar artery; H, hypertension; D, diabetes mellitus; L, hyperlipidemia; S, smoking; C, coronary artery disease.
* Recanalized after intraarterial abciximab injection.
† Improved during hospitalization.
‡ First stent was trapped by the tight stenosis and had to be deployed proximal to the lesion site; thus, a second stent was used for distal angioplasty.
§ Two stents used for long length of the lesion.
Case No. Clinical Follow-up Angiographic Follow-up Duration (mo) Clinical Outcome Duration (mo) Restenosis (%) 1 10 Improved, residual dizziness 0.5 0 2 12 Improved, unrelated TIA at 3 mo 3 0* 3 11 Improved 6 0 4 10 Improved, residual dizziness 6 14 5 13 Improved 6 10 6 12 Improved 12 0 7 18 Improved, unrelated TIA at 15 mo 15 0 8 23 Improved, unrelated minor stroke at 19 mo 17 5 9 20 Improved 17 0 10 45 Improved, residual dizziness 25 0 11 41 Improved 41 10 12 6 Improved 13 7 Improved 14 41 Improved 15 7 Improved 16 10 Improved, thalamic ICH at 2 mo 17 6 Improved Note.—TIA indicates transient ischemic attack; ICH, intracranial hemorrhage.
* Includes both verterbral artery and basilar artery lesions.
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