Atherosclerotic disease of the basilar artery (BAAD) is a known cause of brainstem infarction. Frequent complications of endovascular treatment led to drug treatment as first choice, although it does not treat the cause. The self-expanding Solitaire AB stent has potentially beneficial properties in the treatment of BA stenoses. We compared balloon-only dilation (B), stent-assisted balloon dilation (StB), and sole Solitaire (SO) implantation without balloon dilation for safety and efficacy in the treatment of BAAD. We retrospectively analyzed the outcomes of patients with symptomatic BAAD, who received endovascular treatment in our department. Patients received digital subtraction angiography (DSA) follow-up 3, 6, and 9 months and annually thereafter. All treatment complications, strokes and restenoses were investigated. Twenty-five patients were treated using SO, including seven in the acute stroke setting. Forty-two patients received treatment with B (n = 9) or StB (n = 33), including 24 in the acute setting. Periinterventional complications appeared in B and StB group only. Median DSA follow-up was 441 days (0-2433 days). In-stent restenosis occurred in 4% in the SO group, 24% in the B/StB group. Patients treated with SO had a longer time to retreatment. The risk of complications was generally lower with SO, and SO showed a remodeling effect in which the vessel diameter slowly increased in the follow-up examinations. In the treatment of symptomatic BAAD, SO showed equal safety and efficacy compared to B and StB. The lower rate of perforator infarction may be due to SOs’ principle of slow remodeling.
Gottberg et al. (Sat,) studied this question.