Retrograde angioplasty for basilar artery stenosis: bypassing bilateral vertebral artery occlusions

Case report

Paul T. L. Chiam Department of Neurosurgery and Toshiba Stroke Research Center,
Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York

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 M.B.B.S., M.R.C.P.
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J Mocco Department of Neurosurgery and Toshiba Stroke Research Center,
Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York

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 M.D., M.S.
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Rodney M. Samuelson Department of Neurosurgery and Toshiba Stroke Research Center,
Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York

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 M.D.
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Adnan H. Siddiqui Department of Neurosurgery and Toshiba Stroke Research Center,
Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York

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 M.D., Ph.D.
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L. Nelson Hopkins Department of Neurosurgery and Toshiba Stroke Research Center,
Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York

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 M.D.
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Elad I. Levy Department of Neurosurgery and Toshiba Stroke Research Center,
Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; and
Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York

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Basilar artery angioplasty with or without stenting is an emerging and promising treatment for vertebrobasilar insufficiency that is refractory to medical therapy. The usual approach is via a transfemoral route, with access directly through the vertebral artery (VA). An approach from the anterior circulation via the posterior communicating artery has been reported for optimal stent positioning and deployment across basilar apex aneurysms. No similar technique has been reported for treatment of midbasilar stenosis. The authors report a case of severe symptomatic basilar stenosis in which both VAs were occluded. The only option was to perform retrograde basilar angioplasty via the posterior communicating artery. This useful technique should be part of the armamentarium for the percutaneous treatment of symptomatic vertebrobasilar insufficiency for the occasional patient in whom occlusion or tortuosity precludes direct access to the VA.

Abbreviations used in this paper:

BA = basilar artery; ICA = internal carotid artery; PCA = posterior cerebral artery; PCoA = posterior communicating artery; VA = vertebral artery; VBI = vertebrobasilar insufficiency.
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