Endovascular therapy for stenosis of the petrous or cavernous portion of the internal carotid artery: percutaneous transluminal angioplasty compared with stent placement

Terada, Tomoaki; Tsuura, Mitsuharu; Matsumoto, Hiroyuki; Masuo, Osamu; Tsumoto, Tomoyuki; Yamaga, Hiroo; Itakura, Toru

doi:10.3171/jns.2003.98.3.0491

Cited by 45 publications

(26 citation statements)

References 31 publications

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“…Only PTA cannot achieve full dilation of petrous lesions because of the surrounding petrous bone. PTA lowered the incidence of restenosis, 18) but elastic recoil and vessel dissection occurred if over-sized PTA balloons were used. 6,21) Technological advances have facilitated the approach to cerebral vessels, and intravascular treatment using balloons and stents has become increasingly safe and effective.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…17,20) Some of these complications may also occur after stent placement. 8,10,18,20,22) The effectiveness of intracranial stenting was first confirmed in patients who underwent vertebrobasilar artery stenting. 8,10,22) As the vertebrobasilar artery can be approached directly from the femoral artery, navigation in this vessel is easier than in the internal carotid artery (ICA) system with tortuous cavernous and petrous portions.…”

Section: Introductionmentioning

confidence: 99%

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

Ito

Kai

Hyodo

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Percutaneous transluminal angioplasty (PTA) and stent placement are effective in patients with stenosis of the cavernous or petrous portion of the internal carotid artery (ICA), but the long-term outcomes remain unclear. The present study evaluated long-term outcomes in 54 patients treated by PTA or stent placement for stenotic lesions involving more than 50% of the cavernous or petrous portion of the ICA with ischemic symptoms or without ischemic symptoms if cerebral blood flow on single photon emission computed tomography images was decreased by 20% compared with the contralateral side. Followup magnetic resonance, three-dimensional computed tomography, and conventional angiography were performed. Patient condition in the follow-up period was investigated using telephone interviews or questionnaires. PTA was used to treat 13 lesions and stent placement for 41 lesions. Permanent and transient complications occurred in 2 and 5 patients, respectively. The morbidity rate was 13% (7 of 54 patients). The follow-up period ranged from 3 to 80 months (mean 29.9 months), and restenosis and occlusion were recognized in 4 patients (7.4%). Five patients died (2 of malignancy and 3 of myocardial infarction) during the follow-up period. PTA and stent placement are safe and effective in patients with stenosis of the cavernous or petrous portion of the ICA, and result in low long-term rates of restenosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Ito

Kai

Hyodo

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…5,14 -24,35-37 Some authors have proposed theoretical advantages of stent placement over primary angioplasty by preventing early elastic recoil and negative remodeling. 38,39 A recent report of a comparison between angioplasty and stent placement in a small group of patients (Nϭ24) suggested that stent placement may be better in terms of early and late lumen gain for intracranial stenosis. 39 No other direct radiographic or clinical outcome comparisons are available in the literature to date.…”

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confidence: 99%

Comparison of Primary Angioplasty With Stent Placement for Treating Symptomatic Intracranial Atherosclerotic Diseases

Siddiq

Vázquez

Memon

et al. 2008

Stroke

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Background and Purpose-We sought to compare the clinical outcomes between primary angioplasty and stent placement for symptomatic intracranial atherosclerosis. Methods-We retrospectively analyzed the clinical and angiographic data of 190 patients treated with 95 primary angioplasty procedures and 98 intracranial stent placements (total of 193 procedures) in 3 tertiary care centers. Stroke and combined stroke and/or death were identified as primary clinical end points during the periprocedural and follow-up period of 5 years. The rates of significant postoperative residual stenosis (Ն50% of greater stenosis immediately after the procedure) and binary restenosis (Ն50% stenosis at follow-up angiography within 3 years) were also compared. The comparative analysis was performed after adjusting for age, sex, and center. Results-Fourteen procedures in the angioplasty-treated group (15%) and 4 in the stent-treated group (4.1%) had significant postoperative residual stenosis (relative risk [RR]ϭ2.8, 95% CI, 0.85 to 9.5, Pϭ0.09, for the adjusted model). There were 3 periprocedural deaths (1.5%), 1 in the angioplasty group (1.1%) and 2 in the stent-treated group (2.0%) and 14 periprocedural strokes (7.3%), 7 periprocedural strokes in each group (7.4% and 7.1%, respectively; hazard ratioϭ1.1; 95% CI, 0.57 to 1.9, Pϭ0.85). Angiographic follow-up was available for 134 procedures (66 angioplastytreated and 68 stent-treated cases). Forty-eight procedures (36.1%) had evidence of binary restenosis (25 of 66 angioplasties, 23 of 68 stents, Pϭ0.85). Binary restenosis-free survival at 12 months was 68% for the angioplasty-treated group and 64% for the stent-treated group. There was no difference in follow-up survival (stroke, or stroke and/or death) between the angioplasty-treated and the stent-treated groups (hazard ratioϭ0.54; 95% CI, 0.11 to 2.5, Pϭ0.44 and hazard ratioϭ0.50; 95%, CI 0.17 to 1.5, Pϭ0.22, respectively, after adjusting for age, sex, and center). The strokeand/or death-free survival at 2 years for the angioplasty-treated group and the stent-treated group was 92Ϯ4% and 89Ϯ5%, respectively. Conclusions-Stent treatment for intracranial atherosclerosis may lower the rate of significant postoperative residual stenosis compared with primary angioplasty alone. No benefit of stent placement over primary angioplasty in reducing stroke or stroke and/or death could be identified in this study. (Stroke. 2008;39:2505-2510.)

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“…6) To overcome such problems with the balloon catheter, metal stents were introduced with a high expectation, and their effectiveness and favorable therapeutic results have been reported. 7,8) We used coronary stenosis in majority of cases. In the patients reported here, the DWI-positive rate after stenting with flow reversal was 0%, indicating a high preventive effect against distal embolism.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Stenting for Intracranial Internal Carotid Artery Stenosis Using Flow Reversal

Matsuda

Satoh

Hanaoka

et al. 2018

JNET

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Endovascular therapy for stenosis of the petrous or cavernous portion of the internal carotid artery: percutaneous transluminal angioplasty compared with stent placement

Abstract: Stent placement is more effective than PTA for stenosis of the petrous or cavernous portion of the ICA from the viewpoint of initial and late gain in diameter.

Cited by 45 publications

References 31 publications

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

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

Comparison of Primary Angioplasty With Stent Placement for Treating Symptomatic Intracranial Atherosclerotic Diseases

Evaluation of Stenting for Intracranial Internal Carotid Artery Stenosis Using Flow Reversal

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