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FIG 3. Case 3.
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.
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