Neurointervention.  2012 Feb;7(1):27-33. 10.5469/neuroint.2012.7.1.27.

Usefulness of Stent Implantation for Treatment of Intracranial Atherosclerotic Stenoses

• Kim KS
• Hwang DH
• Ko YH
• Kang IW
• Lee ES
• Han YM
• Min SJ
• Kim IS
• Hur CW
• Lui S
• Lin T
• You T
• Shi H
• Li L

• KMID: 1783996
• DOI: http://doi.org/10.5469/neuroint.2012.7.1.27

Abstract

PURPOSE
We evaluated the usefulness of intracranial stent implantation for treating patients with atherosclerotic stenosis and with recurrent, ischemic, neurological symptoms despite having undergone medical therapy.
MATERIALS AND METHODS
Between March 2004 and April 2010, we attempted intracranial, stent-assisted angioplasty in 77 patients with 85 lesions (anterior circulation 73 cases, posterior circulation 12 cases) and who had ischemic neurological symptoms with more than 50% major cerebral artery stenosis. We analyzed the results regarding the technical success rate, complication rate, and restenosis rate during the mean 29.4 month follow-up period.
RESULTS
Intracranial stent implantation was successfully performed in 74 cases (87.1%). In nine cases among the 11, failed cases, stent implantation failure was due to the tortuosity of the target vessel. One patient experienced middle cerebral artery rupture during the procedure, and we embolized the vessel using a microcoil. Five patients developed cerebral infarction in three weeks after the procedure, three of whom improved using conservative management, although the other, two patients expired. The mean number of residual stenoses decreased from 72.3% to 14.7%. Three patients demonstrated significant in-stent restenosis, i.e. more than 50%, during the follow-up period.
CONCLUSION
As stent-assisted angioplasty in intracranial, atherosclerotic stenosis is effective and relatively safe, it can be considered as an alternative treatment for patients with recurrent, ischemic, neurologic symptoms despite having undergone medical therapy.

Keyword

Atherosclerosis, Intracranial; Stents; Angioplasty

MeSH Terms

Angioplasty
Cerebral Arteries
Cerebral Infarction
Constriction, Pathologic
Follow-Up Studies
Glycosaminoglycans
Humans
Intracranial Arteriosclerosis
Middle Cerebral Artery
Neurologic Manifestations
Rupture
Stents
Glycosaminoglycans

Figure

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  Fig. 1 62-year-old male who presented left-side hemiparesis and dysarthria.A. Diffusion-weighted MRI revealed acute infarction in the right parietal lobe.B. Pre-procedural angiography showed luminal narrowing of the distal right ICA.C. Post-procedural angiography showed good patency of the flow.D. Follow-up angiography eight months after the procedure showed no restenosis.

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  Fig. 2 69-year-old female who presented right hemiparesis and dysarthria.A. Angiography showed severe stenosis in the left MCA in the distal M1 portion.B. After stent-assisted angioplasty, the left MCA was completely recanalized.C, D. The patient presented with recurrent ischemic neurologic symptoms on the contralateral side six months after the procedure. As her symptoms were related to severe stenosis in the right MCA M1 segment, stent-assisted angioplasty was performed.E, F. Follow-up angiography performed both 13 and 19 months after the procedure, shows good flow patency with stent implantation in the right and left MCA, respectively.

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