Transluminal Balloon Angioplasty for Treatment of Basilar Artery Stenosis: A Case Report

Introduction Symptomatic basilar artery stenosis is a significant contributor to ischemic stroke and transient ischemic attacks (TIA) and must be appropriately treated. Due to the challenging anatomy of the basilar artery, conservative methods such as antiplatelet therapy and lifestyle modification remain the primary choices for treatment. However, in some cases angioplasty must be necessary to avoid cerebrovascular complications. (1-3) Case Presentation A 72-year-old male presents with a history of hypertension, hypercholesterolemia, and recurrent TIAs in the vertebrobasilar territory, occurring despite antiplatelet therapy. Initial angiography revealed 95% stenosis in the basilar artery and 50% stenosis in the left internal carotid artery. The patient was admitted for elective transluminal balloon angiography (TBA) to address the severe basilar stenosis. Post-procedural complications included diplopia, rightward gaze palsy, right ptosis, ataxia, and dysmetria. However, no recurrent TIAs were reported after the procedure. Discussion Transluminal balloon angioplasty offers potential benefits in reducing the risk of stroke in patients with significant symptomatic basilar artery stenosis. However, it is also associated with considerable risks, most commonly ischemic strokes in brainstem regions, supplied by pontine arteries. (1-3) This case highlights the technical challenges of treating basilar artery stenosis and the high likelihood of complications when addressing posterior circulation stenoses. While randomized trials and retrospective studies from recent years advocate endovascular interventions for high-grade stenoses, the optimal timing and appropriate selection of patients remain areas requiring further research. (1-3) Conclusions This case highlights the complexity of managing basilar artery stenoses, where complications can result in severe neurological outcomes. Appropriate selection of patients is necessary to minimize the risks of TBA and posterior circulation stenoses.