Angioplasty with Stenting of the Only Vertebral Artery

D.V. Svistov, D.V. Kandyba, A.V. Savello, E.D. Alekseev, S.N. Konovalenko

(Medicomilitary Academy, Saint Petersburg)

Angioplasty is a prospective method of intravascular correction of atherosclerotic and traumatic lesions of major cerebral arteries with the purpose of stroke prevention. Today it is being studied in detail. Remodeling of a vascular bed is characterized by a more stable and long-term results in stenting, which prevents elastic and proliferative restenosis.

Male patient P., aged 41, was admitted to the Clinic of Neurosurgery on October 23, 2003. Earlier (23.02.03) he had suffered an acute disorder of cerebral circulation in the vertebrobasilar region, which was of an ischemic type. Neurological examination revealed nystagmus, reflexes of oral automatism, dysgraphia, dysarthria, staccato speech, left-side hemihyperesthesia. Data of MR-angiography were indicative of occlusion of the right vertebral artery (VA) in its opening, echeloned stenosis of the only left VA. Ultrasonic examination of neck vessels demonstrated generalized atherosclerosis, minor stenosis of both ICA, occlusion of the right VA, stenosis of V1 and V3 segments of the left VA with signs of circulatory insufficiency in the region of the left posterior cerebral artery. Primary stenting of echeloned stenosis of the left VA was performed on October 29, 2003 (BOA 4.5-12 and BOA 3.5-10 stents). Anatomic stenoses of VA, a pressure gradient in the left VA (20 mmHg before plasty) and circulatory insufficiency in the vertebrobasilar region were eliminated (according to data of ultrasonic examination). Neurological examination showed regression of sensation disorders.

Male patient D., aged 25, was admitted on November 11, 2003 with sequelae of knife injury of a neck. He sustained a punctured-incised wound with damage of the right VA and the upper primary trunk of the right brachial plexus on August 17, 2003. Neurological examination revealed Erb-Duchenne paralysis on the right and aneurysmal noise in the left half of he neck. Data of ultrasonic examination and selective cerebral angiography confirmed occlusion of the right VA at the level of C6-7 vertebrae. Arteriovenous fistula and false aneurysm of the left VA at the level of C4-5 vertebrae were diagnosed. Stenting of the left VA with an isolating graft-stent (Jostent 008PG28) was performed on November 18, 2003. The fistula and aneurysm were excluded from blood flow simultaneously. A control angiographic examination, carried out on the first day, showed regression of angiographic signs of stealing and shunting, as well as regression of clinical manifestations of fistula. The femoral artery was sutured with the help of the Prostar XL 8F Perclose device after an introducer removal. Neurolysis of the brachial plexus trunks on the right was performed on November 27, 2003. There was a tendency to regression of focal symptoms postoperatively.

The demonstration goal was to show potentialities of methods of intervention radiology in correction of serious lesions of cerebral vessels under conditions of a strongly limited reserve of collateral circulation.