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AJNR - American Journal of Neuroradiology

A and B, Pretreatment anteroposterior (A) and lateral (B) views of the left internal carotid artery show stenoses of the cavernous segment and of the A1 segment of the left anterior cerebral artery (arrows).

C and D, After unprotected PTA, angiograms show a dissection of the cavernous carotid artery (closed arrow, C) and compromise of distal perfusion (open arrow, C). This progressed quickly to complete occlusion of the left internal carotid artery (D). Prompt reconstitution of the supraclinoid internal carotid artery via the ophthalmic artery (arrow, D) helped to mitigate the effects of the temporary occlusion.

E, Immediate reopening of the internal carotid artery is evident after placement of an AVE 3.5 x 8-mm GFX stent. Arrows indicate the stent placement.

F, Follow-up angiogram 6 months later shows healing of the stent site, and a smooth luminal contour.

A, Oblique view of the right vertebral artery shows a relatively long segment of tight stenosis from the end of which arises the right PICA (arrow). A second area of atherosclerotic narrowing in the basilar artery was not treated on this occasion. The left vertebral artery was occluded distal to the left PICA.

B, 3D surface-rendered image of the right vertebral artery before treatment shows the circumferential "apple-core" configuration of the lesion and served as a baseline for evaluation of the hypoplastic PICA (arrow).

C, After predilatation, as described in the text, and placement of an AVE 4 x 18-mm GFX stent expanded with low pressures, a satisfactory lumen is observed.

D, 3-month follow-up angiogram shows no evidence of restenosis at the stent site (arrows). The right PICA remains patent.

A, Lateral projection of the left vertebral artery shows a critically tight stenosis (straight arrow) of the vessel proximal to the origin of the PICA (curved arrow). An ipsilateral stenosis of the external carotid artery causes opacification of the collateral vessels, resulting in superimposition of the hypoglossal branch (open arrow) of the neuromeningeal trunk on the stenosis of the left vertebral artery.

B, After slow PTA with 2-mm, 3-mm, and 3.5-mm balloons, a satisfactory appearance of the stenosis site is seen (closed arrow). Distal disease in the proximal basilar artery (open arrow) is more apparent now. It was decided during the procedure not to treat the upper site.

C, An AVE 4 x 12-mm GFX stent was deployed in the stenosis site (arrows indicate placement) proximal to the left PICA. The Mailman wire is still across the lesion site within the stent. Conventional planar and 3D views (not shown) were used with and without subtraction to determine that the stent expansion was satisfactory, precluding the need to risk further postdilatation.

D, 3-month poststent angiogram shows mild intimal growth through the struts of the stent (arrows) but no evidence of hemodynamically significant restenosis.