Intrakranielles Stenten bei vertebrobasilären Stenosen - eine Fallbeobachtung im Langzeitverlauf

In the observed study that transpired from March 2006 until March 2007, eleven patients with symptomatic intracranial stenosis of the vertebrobasilar arteries were treated with intracranial stent placement. Retrospectively, the focus was to analyze the patients regarding success rate, clinical outcome and long term course. Of special interest were the patients who suffered ischemic symptoms of a vertebrobasilar insufficiency despite aggressive medical treatment. In this report eleven patients had thirteen stenotic lesions of the vertebrobasilar arteries. All subjects were deemed suitable for intracranial stent placement. Nine of eleven patients had an antithrombotic medication mostly consisting of Acetylsalicylsäure. Three patients had an aggressive medical treatment including ASS, Clopidogrel , Marcumar and Clopidogrel. Despite the medication, these patients developed symptoms of vertebrobasilar insufficiency. The mean stenotic degree before endovascular treatment was 15,6 % (SD 2,64). Ultimately, the success rate was 92,3%. After interventional stent placement the mean remaining stenotic degree was 15,6 % (SD 3,62). The pre-procedural complication rate was 9,1 %. Non-neurological complications were not discerned. In 66,7 % of the cases, a post-procedural diffusion-weighted MRI showed diffusion impairment. Despite the lesions seen in the MRI, only one patient developed a degraded neurological condition. In 72,7% of the cases the patients presented a significantly improved neurological state. In particular, this was observed with patients who failed antithrombotic therapy. As such, no neurological complication was observed in the long term. The rate of ischemic events was 27,3 %, while the rate of ischemic events in the area of the treated vessel was 18,2 %. In one case, (9,1 %) an asymptomatic restenosis of 54 % was observed. These results indicate that patients with severe intracranial stenosis who failed antithrombotic medication may benefit from interventional therapy. The primary therapy of symptomatic intracranial stenosis should rely on conservative These results indicate that patients with severe intracranial stenosis who failed antithrombotic medication may benefit from interventional therapy. The primary therapy of symptomatic intracranial stenosis should rely on conservative measures.