Intracranial angioplasty and stent placement for direct cerebral revascularization of nonacute intracranial occlusions and near occlusions

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors reviewed their experience in 7 cases of nonacute intracranial occlusions and near occlusions in which the patients underwent intracranial angioplasty and stent implantation for direct cerebral revascularization.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between 2005 and 2008, 4 men and 3 women underwent direct cerebral revascularization of nonacute intracerebral occlusions or near occlusions. Five patients had chronic angiographically documented occlusion and 2 patients had chronic angiographically documented near occlusions. The locations of the treated vessels included 2 supraclinoid internal carotid arteries, 4 middle cerebral arteries, and 1 vertebral artery. Prior to intervention, all patients were symptomatic and experienced strokes ipsilateral to their occlusions. In addition, all patients had clinical or radiographic evidence of ongoing hemodynamic compromise. Five patients underwent successful intracranial angioplasty and stent placement and 2 patients underwent successful intracranial balloon angioplasty alone. The mean time from documented vessel occlusion to treatment was 35 days. All patients had successful revascularization determined using the Thrombolysis in Cerebral Infarction (TICI) scale: TICI Score 3, 2b, and 2a in 4, 2, and 1 patient, respectively, and the mean residual stenosis was 38%.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>After uneventful technical procedures, 1 patient suffered a perforator vessel stroke and 1 patient suffered a fatal hemorrhage. Mean modified Rankin Scale score of 2 (range 1–5) and mean Glasgow Outcome Scale score of 4 (range 1–6) were achieved during a mean clinical follow-up period of 399 days (range 1–840 days). Asymptomatic restenosis was documented in 4 patients, 1 underwent bypass retreatment, and 1 patient received repeated balloon angioplasty.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Combined intracranial angioplasty and stent placement is a potential treatment option in selected patients for the direct revascularization of nonacute intracranial occlusions and near occlusions. Whether this represents a substantial risk reduction compared with the best medical therapy or a long-lasting treatment option is unknown.</jats:p></jats:sec>

Endovascular treatment of symptomatic intracranial stenosis with the Wingspan stent system and Gateway PTA balloon: a multicenter series of 60 patients with acute and midterm results

“…[4][5][6]9,10,12,13,15,19,21 These figures may still be advantageous, given the considerable morbidity and mortality levels that are related to the natural history of the disease itself. In 2006, high rates of ipsilateral ischemic recurrence (38.2%) and vascular death (8.8%) were reported in the Groupe d'Etude des Sténoses IntraCrâniennes Athéromateuses Symptomatiques (GESICA) study.…”

Clinical Study of Symptomatic Nonacute Intracranial Large Arterial Occlusion with Endovascular Recanalization

“…Although a growing number of studies have reported that intravascular recanalization appeared to be safe and efficient for symptomatic NA-ILAO. [7][8][9][10][11][12] However, there was heterogeneity of outcomes and perioperative complications for endovascular recanalization, 13 and it was believed that there were differences in the difficulty and risk at different locations of occlusion. 2,14 The high perioperative complication rate and high postoperative restenosis/re-occlusion rate 15 greatly limit its wide application.…”

Interventional Management of Intracranial Stenosis

“…Time since the qualifying event was an independent predictor of risk for stroke recurrence in the WASID trial with the highest risk occurring if enrolled within 17 days after a symptomatic event [4]. Although chronic severe intra-arterial occlusion has been treated with angioplasty and stent placement [57], early revascularization has been emphasized given the predominant risk of recurrent stroke in the early post-event period. However, acute revascularization of intracranial vessels may confer higher periprocedural complications.…”