Percutaneous Stenting of a Vertebral Artery Supplying the Entire Brain
A63-year-old woman was referred for evaluation of a transient ischemic attack with right arm and leg involvement. On examination, she had a right neck bruit. The head CT scan showed a small, old ischemic infarction in the periventricular area of the right frontal lobe. Digital substraction angiography revealed a total occlusion of both internal carotid arteries, a severe stenosis of the origin of the right vertebral artery (Figure⇓, upper left), and an atretic left vertebral artery. The right vertebral artery supplied the vertebrobasilar circulation and the right and left hemispheres (Figure⇓, right). Because of this functionally unique cerebral blood supply and location of the stenosis, the patient was not considered a candidate for surgical revascularization. Accordingly, she underwent percutaneous stenting using adjunctive abciximab with excellent angiographic results (Figure⇓, lower left). During the brief balloon inflation (<15 s) the patient did not develop neurological or hemodynamic symptoms. The hospital stay was uneventful, and she was discharged the next day. At 6 months, she had no recurrent neurological events. To our knowledge, this is the first report describing successful percutaneous stenting of a dominant vertebral artery supplying the entire brain.
- Copyright © 2001 by American Heart Association