Staged surgical treatment for symptomatic vertebrobasilar artery stenosis: combined treatment with endovascular angioplasty and bypass surgery.

Abstract

Because the early risk of stroke recurrence in patients with posterior circulation infarctions is high, patients with vertebrobasilar events require active preventive treatment. Previous reports have described the use of balloon angioplasty and stenting or surgical revascularization to the vertebrobasilar artery area. To compensate for the disadvantages of these techniques, we combined endovascular and surgical treatments in a patient with symptomatic vertebrobasilar artery stenosis. After endovascular surgery, we continued medical therapy to stabilize the blood flow in the posterior circulation. Superficial temporal artery-superior cerebellar artery bypass was planned for the chronic stage (∼1-2 months). Three cases (2 vertebral artery stenosis, 1 basilar artery stenosis) presented with recurrent transient ischemic attacks or deteriorating symptoms under intensive medical treatment. We conducted staged therapy using balloon angioplasty followed by superficial temporal artery-superior cerebellar artery bypass. All patients were symptom-free after treatment with the combined therapy. Our staged therapy may be an effective treatment for symptomatic vertebrobasilar artery stenosis.