Diagnostic and Interventional Radiology
Interventional Radiology - Case Report 2016

Flow diverter as a rescue therapy for a complicated basilar angioplasty

1.

Department of Radiology, GATA Haydarpaşa Teaching Hospital, İstanbul, Turkey.

2.

Department of Radiology, GATA Haydarpaşa Teaching Hospital, İstanbul, Turkey

3.

Department of Radiology GATA Haydarpaşa Teaching Hospital, İstanbul, Turkey.

4.

Department of Neurology, GATA Haydarpaşa Teaching Hospital, İstanbul, Turkey.

5.

From the Department of Radiology, Gülhane Military Academy of Medicine, Haydarpaşa Research and Training Hospital, İstanbul, Turkey

Diagn Interv Radiol 2013; 19: 345-348
DOI: 10.5152/dir.2013.073
Read: 555 Downloads: 359 Published: 03 September 2019

Abstract

Intracranial atherosclerotic disease is a major cause of ischemic stroke. Stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis was terminated prematurely due to a high stroke and death rate in patients randomized for intracranial stent placement. However, for some patients, angioplasty and/or stent placement remains the best approach. Flow diverters (FDs) are designed to produce a hemodynamic flow diversion by constituting a laminar flow pattern in the parent artery and are mainly used in non-ruptured complex wide-neck aneurysms as well as in ruptured aneurysms. Herein, we present a case where an FD was used in a complicated angioplasty for basilar artery atherosclerosis. A 72-year-old female patient was admitted to our hospital with left side weakness and vertigo. Her diffusion magnetic resonance imaging and magnetic resonance angiography showed right-sided pontine and left-sided occipital acute infarcts with left-sided pontine and right-sided occipital chronic infarcted areas and preocclusive mid-basilar stenosis. The patient was under supervised medical treatment. Despite chronic brain stem and occipital infarcts her modified Rankin Scale was 2. Diagnostic angiography showed no posterior communicating arteries and no pial-pial collaterals and a critical mid-basilar artery stenosis. We decided to perform intracranial angioplasty to increase the perfusion of posterior circulation and reduce the risk of additional embolic infarcts. Angioplasty was complicated with dissection and vessel perforation. We used an FD for rescue therapy to avoid rebleeding. The patient was discharged with good clinical and angiographic results.

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