Guideline for Intracranial Stenting of Symptomatic Intracranial Artery Stenosis: Preliminary Report

Lee, Byung Hee

Abstract

The annual stroke and death rate in symptomatic patients with intracranial atherosclerotic stenosis has been published as high as 20% or even more. According to the studies of the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) and Extracranial-intracranial bypass surgery did not prove to be effective for prevention of stroke or improvement of prognosis of intracranial atherosclerotic stenosis. Increasing experience of angioplasty and stenting in intracranial atherosclerotic stenosis and technological advances during the past two decades have led the current results of complication rates as low as 10% with success rates of up to 90% and significant low recurrence rate of stroke after endovascular treatment of intracranial atherosclerotic stenosis. Growing evidence supports the endovascular treatment to be a primary method of treatment of intracranial atherosclerotic stenosis. This has engendered the need for the treatment guideline of the procedure such as indication, procedure's protocol, evaluating uniform methods of the results. In 2006, the Guideline Research Group in the Korean Society of Interventional Neuroradiology had conferences to provide the guideline and came to propose this preliminary result in this paper. The indication is symptomatic patients with 50-70% stenosis or patients having progressively aggravating stenosis. The procedure interval being as short as possible from the symptom onset would result in better outcome. In terms of treatment method, previous reports showed that both balloon angioplasty and stenting were good for success rate, complication rate and effectiveness for preventing stroke but the balloon angioplasty had more risk of dissection and more frequency of re-procedure than stenting. We also proposed reporting guideline at the periods of pre and post-procedure and mid and long-term follow-up.