Angioplasty for Symptomatic Intracranial Stenosis

Abstract

Background and Purpose-Medical treatment of symptomatic intracranial stenosis carries a high risk of stroke. This study was done to evaluate the clinical and angiographic outcomes after intracranial angioplasty for this disease. Methods-A total of 120 patients with 124 intracranial stenoses were treated by primary angioplasty. All patients had neurologic symptoms (stroke or transient ischemic attack) attributable to intracranial stenoses Ն50%. Angiograms were evaluated before and after angioplasty for the degree of stenosis. Results-Pretreatment stenoses varied from 50% to 95% (mean 82.2Ϯ10.2). Post-treatment stenoses varied from 0% to 90% (mean 36.0Ϯ20.1). There were 3 strokes and 4 deaths (all neurological) within 30 days of the procedure, giving a combined periprocedural stroke and death rate of 5.8%. A total of 116 patients (96.7%) were available for a mean follow-up time of 42.3 months. There were 6 patients who had a stroke in the territory of treatment and 5 additional patients with stroke in other territories. Ten deaths occurred during the follow-up period, none of which were neurological. Including the periprocedural stroke and deaths, this yielded an annual stroke rate of 3.2% in the territory of treatment and a 4.4% annual rate for all strokes. Conclusion-Intracranial angioplasty can be performed with a high degree of technical success and a low risk of complications. Long-term clinical follow-up of intracranial angioplasty patients demonstrates a risk of future strokes that compares favorably to patients receiving medical therapy.

Long-Term Outcome of Angioplasty or Stent Placement for Stenosis of the Cavernous or Petrous Portion of the Internal Carotid Artery

“…Approximately 10% of our patients experienced complications after the initial PTA/stent treatment for intracranial stenotic disease; this complication rate agrees with earlier reports. 6,14,17,18,20) An important factor underlying the development of complications was distal embolism during the procedures. Our long-term outcomes were satisfactory and, compared to others, 1,4,10) the re-stenosis rate in our series was low.…”

“…Percutaneous transluminal angioplasty (PTA) for intracranial stenotic disease was introduced in the 1980s, 14) followed by combined stent placement in the 1990s. 8,22) PTA is used to treat stenotic lesions of the intracranial artery, but is associated with complications such as elastic recoil, acute obstruction, plaque embolization, arterial dissection, and occlusion of the perforating artery.…”

Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis

“…Similar data were obtained in other angiography studies, which showed high-grade intracranial lesions in 35%-49% of cases. 1,7,13 In our study, we did investigate 2 ICA segments in detail, especially those in which the MR imaging artifact problem frequently occurs and in which angioplasty may not be complicated by an extremely tortuous arterial course. 19 Tandem stenosis of the ICA is of special interest in patients undergoing surgical ICA revascularization or stent placement.…”

“…9,10 Endovascular treatments involving angioplasty for 50%-99% ICA stenosis have also been applied but are considered experimental approaches in need of validation by controlled studies. [11][12][13] Because the course of intracranial ICA is complicated due to its tortuosity and variability, classification of this portion of the vessel may differ between authors, [14][15][16] in turn complicating interpretation of the data. The "gold standard" used to assess the intracranial ICA remains digital subtraction angiography (DSA).…”

Angioplasty and Stenting of Atherosclerotic Middle Cerebral Arteries with Wingspan: Evaluation of Clinical Outcome, Restenosis, and Procedure Outcome

“…10 The use of conservative angioplasty and the Wingspan stent (Boston Scientific, Natick, Massachusetts) as a self-expanding nitinol stent specifically developed for intracranial atherosclerotic stenosis has brought down the periprocedural stroke or death rate from 9.5% (95% CI, 7.0%-12.0%) in a meta-analysis to 4.5%. 11,12 The MCA is a common location of stenosis in the anterior circulation; it is more peripherally located and of a relatively smaller caliber compared with the other common locations of intracranial stenosis. It is hypothesized that intracranial atherosclerosis located at the MCA is technically more challenging for angioplasty and stent placement and is associated with a suboptimal treatment outcome.…”