The endovascular treatment of atherosclerotic intracranial arterial stenoses has previously been based on balloon dilatation or the deployment of a balloon expandable stent. Both methods have advantages (balloon: flexibility; balloon expandable stent: high radial force) and drawbacks (balloon: risk of elastic recoil and dissection; balloon expandable stent: limited flexibility, risk of injury to the vessel due to excessive straightening, overexpansion at ends of stent). A new combination of balloon dilatation, followed by the deployment of a self-expanding microstent has been applied in 15 patients with atherosclerotic arterial stenoses, symptomatic despite medical treatment. An anatomically and clinically adequate result was achieved in all patients. The initial degree of stenosis was 72% (mean). Balloon dilatation resulted in an average residual stenosis of 54% (mean), reduced further to a mean of 38% after stent deployment. Arterial dissection, occlusion of the target artery or symptomatic distal emboli was not encountered. In one patient, a side branch occlusion occurred after dilatation of a M1 stenosis, with complete neurological recovery. All patients were either stable or improved 4 weeks after the treatment. Recurrent TIA did not occur in any patient. Balloon dilatation and subsequent deployment of a self-expandable stent for the treatment of symptomatic intracranial arterial stenoses combines the advantages of both techniques and allows a rapid, clinically effective and technically safe treatment of these frequently challenging lesions.

The natural course of aneurysm remnants or recurrent aneurysm perfusion after coil treatment is not completely understood. The low risk of bleeding from partially filled aneurysms must be balanced against the procedure-related risks of retreatment. Great caution is recommended for the treatment of asymptomatic recurrent aneurysms.

Within limits, the experimental setup was appropriate for generating occlusions of diameter 2-5 mm of various lengths, simulating ICA, BA and MCA thromboembolism. In this model, thrombus mobilization appeared to be less dependent upon the individual design of the retrieval system than on thrombus fragmentation. The ability to prevent distal embolization is, however, strongly dependent on the ability of a thrombectomy device to capture fragments that are generated during removal of the device.

The phenox clot retriever, a flexible microfilament pattern, might be a useful supplement to the repertoire of currently available devices for endovascular intracranial thrombectomy.