Primary Angioplasty without Stenting for Symptomatic, High-Grade Intracranial Stenosis with Poor Circulation

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Fig 1.
A 65-year-old man with symptomatic severe basilar artery stenosis, refractory to medical therapy (case 1). A, Angiogram of the left vertebral artery reveals severe stenosis of the vertebrobasilar junction (angiographic characteristic: TICI 1). B, High-resolution MR imaging confirms the atherosclerotic lesion and shows the eccentric plaque located at the vertebrobasilar junction and the surface of the plaque enhancement. C, Immediate angiogram after primary angioplasty with a 1.5- to 9-mm Gateway balloon; antegrade flow improved and reached TICI grade 2b. D, Angiogram of the left vertebral artery at 14-month follow-up reveals no severe restenosis, and antegrade flow reaches TICI grade 3.
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Fig 2.
A 63-year-old man with symptomatic MCA severe stenosis. (case 26). A, Angiogram of the left internal carotid artery reveals severe stenosis of the left middle cerebral artery (M2 segment) (angiographic characteristic: TICI 2a). B, High-resolution MR imaging confirms the atherosclerotic lesion and shows the plaque located at the M2 branch. C, Immediate angiogram after primary angioplasty with a 2- to 9-mm Gateway balloon reveals that antegrade flow improved and reached TICI grade 2b. D, Angiogram of the left vertebral artery at 6-month follow-up demonstrates no severe restenosis, and antegrade flow reached TICI grade 3.

Patient and lesion characteristics