Update on the natural history of intracranial atherosclerotic disease: A critical review

Figure 1 Seventy-nine years old man with hypertension and hyperlipidemia developed episodic dizziness, visual distortion, dysarthria, and somnolence refractory to anti-platelet therapy using aspirin and dipyridamole. A: Computed tomography of the brain with contrast, CTA protocol and coronal reconstructions, shows severe focal stenosis of the basilar artery (arrow); B: Catheter arteriography of the right vertebral artery during arterial phase in frontal projection confirms 80% stenosis the proximal basilar artery (arrow); C: Fluororadiography during endovascular revascularization using stent angioplasty shows placement of a 3.0 mm × 15 mm Wingspan^® self-expanding nitinol stent (arrow) symmetrically across the stenosis after angioplasty using a 2.5 mm × 9 mm Gateway^® angioplasty balloon catheter; D: Catheter arteriography of the right vertebral artery during the arterial phase in frontal projection at the conclusion of the procedure shows residual 40% stenosis of the basilar artery after angioplasty and stent placement (arrow). Out-patient follow-up with non-invasive imaging using transcranial Doppler ultrasonography shows stable normal velocities in the treated artery. The patient remains stable on aspirin and clopidogrel.