Endovascular treatment of patients with high-risk symptomatic intracranial vertebrobasilar stenoses:long-term outcomes

background and purpose We present the long-term outcome after endovascular treatment of symptomatic intracranial posterior circulation stenoses.Methods 30 patients with symptomatic intracranial posterior circulation stenoses exceeding 70% underwent endovascular treatment between 2006 and 2012.Data regarding presentation,follow-up,procedure details,complications and imaging follow-up were reviewed.All surviving patients underwent a phone interview to establish their current Modified Ranking Scales(MRS).results Stenoses of the intracranial vertebral artery(24 patients)and basilar artery(6 patients)were treated with stents(10 patients),angioplasty alone(13 patients)or both(5 patients).Two procedures failed.One patient(3.3%)died after the procedure,two had stroke(6.6%)and one a subarachnoid haemorrhage without ensuing deficit.Two patients(6.7%)had asymptomatic complications(dissection and pseudoaneurysm).The median clinical follow-up time was 7 years.Of the 29 patients who survived the procedure,6 died due to unrelated causes.Three patients(10%)had recurrent strokes and two(6.7%)a transient ischaemic attack in the posterior circulation.Two patients had subsequent middle cerebral artery strokes.Five(16.7%)patients had recurrent stenoses and three(10%)occlusions of the treated artery.Retreatment was performed in six patients,three(10%)with PTA and three(10%)with stenting.Current MRS scores were as follows:nine MRS 0,eight MRS 1,four MRS 2 and one MRS 4.Conclusions Long-term follow-up after endovascular treatment of high-risk symptomatic intracranial posterior circulation stenoses shows few stroke recurrences.Treatment of intracranial vertebral artery stenosis may be beneficial in appropriately selected patients.