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Tables
- Table 1:
Summary of dependent variables in 10 consecutive patients who underwent basilar artery stenting for symptomatic athero-occlusive disease
Variables Patient-related variables Age >70 years Sex Pre-existing history of diabetes Pre-existing history of significant heart disease Indication for stenting Rate of onset of index event (abrupt vs progressive) Recent failed balloon angioplasty Preoperative acute/subacute infarction Technique-related variables Experience (procedure performed 1999–2000 versus 2001–2003) Primary stenting (versus pre-dilation of target lesion with angioplasty balloon) More than one stent implanted Type of anesthesia (general versus conscious sedation) Major branch artery jailed by stent construct Residual stenosis <20% Perioperative antithrombotic therapy Preloaded with clopidogrel before procedure Intraoperative anticoagulation with documented activated clotting times ≥250 seconds Intraoperative IIb/IIIa inhibitors Postoperative IIb/IIIa inhibitors ≥12 hours Postoperative anticoagulation with heparin and/or warfarin for ≥48 hours Postoperative maintenance therapy with dual antiplatelet agents Anatomic characteristics Lesion location Lesion extension across basilar artery branch ostia Number of patent vertebral arteries contributing to basilar circulation At least moderate stenosis affecting 2 or more major basilar artery branches At least 1 posterior communicating artery giving collateral flow to the basilar artery Lesion characteristics Mori classification Pretreatment stenosis ≥80% Lesion ulceration Prestent lesion lumen ≤0.5 mm Lesion length >10 mm Lesion angle >45° No. Age/Sex Medical Comorbidities Presenting Symptoms Background Treatment at Presentation Initial Treatment for Presenting Index Event Acute Infarcts on Prestent Brain MRI 1 68/F Hypertension, hypothyroidism Hemi-numbness, hemiparesis, dysarthria None Heparin Bilateral cerebellar, left parieto-occipital lobe 2 80/M Hypertension, NIDDM, paroxysmal atrial fibrillation, ischemic coronary artery disease Vertigo, ataxia Aspirin 81 mg/day, warfarin (INR 2.17 seconds) Heparin None 3 76/M Hypertension, tobacco abuse, dyslipidemia Vertigo, drop attacks/syncope, ataxia, dysarthria, blurred vision Clopidogrel Warfarin None 4 57/M Hypertension, ischemic coronary artery disease Hemiparesis, hemi-numbness Clopidogrel, aspirin 325 mg/day tPA, heparin, abciximab None 5 83/F Hypertension, ischemic coronary artery disease, congestive heart failure, hypothyroidism Dysarthria, hemiparesis Warfarin (INR unknown) Heparin, aspirin 325 mg/day None 6 50/M NIDDM, dyslipidemia, tobacco and alcohol abuse Hemiparesis, vertigo, dysarthria, ataxia Clopidogrel, aspirin 325 mg/day × 3 months after balloon angioplasty of Mori B lesion (70% stenosis with 25% residual stenosis) Heparin No prestent brain MRI 7 61/M Hypertension, NIDDM, alcohol abuse Homonymous hemianopsia, drop attacks/syncope Aspirin 325 mg/day × 4 months after acute thrombotic occlusion of basilar artery, 1 month after balloon angioplasty of Mori C lesion (90% stenosis with 50% residual stenosis) Heparin None. 8 72/M Hypertension, IDDM, dyslipidemia, paroxysmal atrial fibrillation, COPD, hypothyroidism, alcohol abuse, ischemic coronary artery disease Vertigo, dysarthria, ataxia Clopidogrel, aspirin 325 mg/day Heparin Left cerebellar 9 69/M Ischemic coronary artery disease, hypertension Dysarthria, hemiplegia None Clopidogrel, aspirin 325 mg/day Left hemi-pontine 10 67/M Hypertension Hemi-numbness, hemiparesis Aspirin (dose unknown) Warfarin, aspirin 325 mg/day None Note:—MRI indicates MR imaging; NIDDM, non–insulin-dependent diabetes mellitus; IDDM, insulin-dependent diabetes mellitus; COPD, chronic obstructive pulmonary disease; INR, international normalized ratio; sec, seconds; tPA, tissue plasminogen activator.
- Table 3:
Characteristics of basilar artery lesions in 10 patients with symptomatic athero-occlusive disease
Patient No. Lesion Length (mm) Angulation (°) Morphology No. Patent Vertebral Arteries Mori Class Ulceration Prestent Lesion Lumen (mm) Stenosis of Luminal Diameter (%) Residual Stenosis after Stenting (%) 1 9.2 0 Concentric 2 B Ulcerated 0.6 77.0 22.8 2 9.0 80 Concentric 2 B Smooth 0.2 81.9 14.5 3 10.0 60 Eccentric 2 B Smooth 1.2 70.5 28.8 4 6.8 45 Eccentric 2 A Ulcerated 0.6 81.0 40.4 5 4.7 0 Concentric 1 A Smooth 0.1 92.9 7.4 6 31.0 45 Concentric 1 C Smooth 0.4 84.0 21.7 7 25.7 0 Eccentric 2 C Smooth 0.2 95.0 43.0 8 7.0 0 Eccentric 2 B Ulcerated 0.5 67.2 32.0 9 5.6 55 Concentric 2 B Smooth 0.4 79.0 0 10 7.4 60 Concentric 2 B Smooth 0.6 78.8 10 Patient No. Time of Onset Relative to Stenting Anti-Thrombotic Medications at Time of Ictus Clinical Presentation Acute Infarcts (Imaging Modality) Catheter Angiography Acute Treatment Maintenance Therapy 5 Immediate Abciximab Deep coma; after withdrawal of support, patient died on poststent day 10 Right cerebellum and anterior pons (CT) Not performed Not applicable Not applicable 6 Day 4 Clopidogrel, aspirin* Vertigo, ataxia Left cerebellum (MRI) No acute abnormality Heparin, clopidogrel, aspirin × 8 days Clopidogrel, aspirin Day 12 Clopidogrel, aspirin Hemiparesis Left middle cerebellar peduncle (MRI) No acute abnormality Heparin, tirofiban × 4 days Enoxaparin, warfarin, aspirin Day 17 Aspirin, enoxaparin, warfarin (INR = 2.03 seconds) Dysarthria, hemiplegia Left pons (MRI) Not performed Heparin, tirofiban × 7 days Enoxaparin, warfarin, aspirin 7 Day 2 Tirofiban Ophthalmoplegia, dysarthria, hemiplegia Right pons (MRI) Stent thrombosis Endovascular mechanical thrombectomy and tirofiban × 2 days Warfarin, tirofiban 8 Day 1 Abciximab Hemiplegia, respiratory failure Right pons (MRI) No acute abnormality Heparin × 6 days. Warfarin, clopidogrel, aspirin Note:—INR indicates international normalized ratio; MRI, MR imaging;
* , when aspirin is indicated, 325 mg/day.
- Table 5:
Clinical outcomes in 10 patients after basilar artery stenting for symptomatic athero-occlusive disease
Patient No. Follow-Up (months) mRS Persistent Symptoms Clinically Significant Interval Events Maintenance Medical Therapy at Last Follow-Up 1 44 0 Clopidogrel, aspirin, atorvastatin 2 46 0 4 hospitalizations for gastrointestinal hemorrhage secondary to excessive anticoagulation Warfarin, aspirin 3 45 3 Chronic imbalance, positional dizzy spells, dominant hand disability related to access site complication MRI 44 months poststent performed to assess recurrent vertigo, diplopia, and gait ataxia while on clopidogrel showed no new infarcts. Angiogram showed 50% concentric stenosis just proximal to stent. Symptoms stabilized on heparin and remained stable on warfarin. Warfarin, clopidogrel, simvastatin 4 39 2 Fixed difficulties with fine motor control Warfarin, aspirin, simvastatin 5 10 days 6 NA NA NA 6 29 3 Fixed gait ataxia, vertigo, dysarthria, dysphagia Aspirin, warfarin, simvastatin 7 38 3 Fixed left hemiparesis, diplopia Warfarin 8 18 3 Fixed left hemiparesis, dysphagia Major myocardial infarction 30 days after discharge from stent hospitalization. Treated by coronary artery bypass grafting surgery and automated implantable cardiac defibrillator Warfarin, lovastatin 9 12 0 Clopidogrel, aspirin, simvastatin 10 8 2 Fixed gait ataxia, dysarthria, dysphagia Aspirin, fenofibrate Note:—mRS indicates modified Rankin score; MRI, magnetic resonance imaging, NA, not applicable.
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