Use of far field basilar artery stenting for recurrent middle cerebral artery ischemia.

Intracranial artery angioplasty and stenting are generally performed for ipsi-territory stroke prevention in stenotic disease; however, few options exist for chronic occlusion of a proximal feeding vessel. In such circumstances intracranial angioplasty and stenting of a neighboring vascular field may improve collateral flow to the territory of the occluded vessel. A case of basilar artery (BA) stenting is presented, performed to improve collateral flow in a man experiencing recurrent middle cerebral artery (MCA) strokes, despite superior temporal artery (STA)-MCA bypass for internal carotid artery occlusion. Following BA stenting, the patient had complete cessation of MCA ischemia and improved cerebrovascular reserve by single photon emission CT. BA stenting was found to be a safe and effective means of improving collateral flow to mitigate recurrent MCA infarctions. Far field interventions should be considered in selected patients who fail other treatments.