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All Journal MNJ (Malang Neurology Journal) Medicinus : Jurnal Kedokteran Majalah Kedokteran Neurosains Neurona Acta Neurologica Indonesia
Vivien Puspitasari, Vivien
Department Of Neurology, Faculty Of Medicine, University Of Pelita Harapan Siloam Hospital Lippo Village
Health Professions Medicine & Pharmacology Neuroscience Public Health

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Fluctuating Neurological Deficits in Severe Proximal Basilar Artery Stenosis: Conservative Management or Endovascular Angioplasty? Yong, Yee Wen; Puspitasari, Vivien; Suryawijaya, Evlyne Erlyana; Goenawan, Vonny Fibrianty
Acta Neurologica Indonesia Vol. 4 No. 3 (2026): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v4i3.142

Abstract

Introduction : Symptomatic basilar artery (BA) stenosis is a high-risk cause of posterior circulation ischemia with potential for recurrent events despite optimal medical therapy. The decision between conservative treatment and endovascular angioplasty remains challenging, particularly in patients with fluctuating symptoms. Case Report : A 62-year-old man with hypertension, poorly controlled type 2 diabetes mellitus, and prior ischemic stroke presented with a two-month history of oscillopsia, intermittent headache, and transient left-sided weakness. Symptoms progressed to persistent imbalance, diplopia, and gait instability. Brain imaging demonstrated acute infarctions in the left thalamus and right anterior pons, multiple chronic posterior circulation infarcts, occlusion of the right vertebral artery, and severe proximal BA stenosis. Digital subtraction angiography (DSA) confirmed approximately 90% symptomatic proximal BA stenosis with reduced flow to the right anterior inferior cerebellar artery. Despite risk factor control, the patient continued to experience symptoms that significantly interfered with daily activities. Given the high procedural risk, conservative management was chosen with close monitoring. A three-month observation period with repeat DSA was planned to reassess the need for angioplasty. Discussion : This case highlights the unstable course of severe BA stenosis despite medical therapy. Although angioplasty may improve perfusion, BA interventions carry substantial risk due to brainstem perforators, with perforator infarction from “snow-plow” effect during angioplasty being a major concern, particularly in proximal lesions. Conclusion : Severe symptomatic BA stenosis presents a challenging therapeutic dilemma. Short-term observation with planned reassessment may be appropriate, but progressive symptoms require close follow-up and early consideration of endovascular treatment.
Co-Authors Amiruddin Aliah, Amiruddin Budhianto Suhadi Cahyono Kaelan, Cahyono Cenweikiawan, Anderson Chandra, Anastasya Djuanda, Gerald Eka J. Wahjoepramono Evelyn Yunita Goenawan, Vonny Fibrianty Harsono, Ivan William Hartoyo, Vinson Ilhamjaya Patellongi Ivan William Harsono Jan S. Purba, Jan S. Japutri, Josephine Julius July M.T. Siahaan, Yusak Nathania Victoria Stevina Pangestu, Aristo Pangestu, Aristo Rinaldi Situmeang, Rocksy Fransisca V. Solansa, Tracy Stevano, Reza Stevina, Nathania Victoria Suryawijaya, Evlyne Erlyana Sutanto, Anyeliria Syarifuddin Wahid Tiffani, Pamela Widjaja, Devita Yong, Yee Wen