Should metallic vascular stents be used to treat cerebrovascular occlusive diseases?
The risks of metallic stent deployment are quite low, and the likelihood of restenosis due to intimal hyperplasia is relatively high, particularly in small to medium-size vessels. The goal of all cerebrovascular interventions is to alleviate symptoms and prevent stroke. For symptomatic carotid bifurcation stenosis, insufficient information is available regarding carotid PTA and stent placement to make any recommendations. Carotid endarterectomy is the treatment of choice in patients with a 70%-99% stenosis of the involved internal carotid artery. For internal carotid artery dissection, stent placement seems to be a reasonable therapeutic alternative that may eventually assume a position as an accepted therapeutic alternative alongside surgery and anticoagulation. The gathering of level I and level II evidence by means of well-designed clinical trials is encouraged. Similarly, the application of stent placement to occlusive disorders of the dural venous sinuses is intriguing. Additional clinical studies should help define the role of stents in these diseases.
Becker
G J
GJ
D000784:Aortic Dissection / Q000628:therapy; D000800:Angioplasty, Balloon; D016477:Artifacts; D016893:Carotid Stenosis / Q000628:therapy*; D002561:Cerebrovascular Disorders / Q000628:therapy*; D016894:Endarterectomy, Carotid; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D016032:Randomized Controlled Trials as Topic; D012851:Sinus Thrombosis, Intracranial / Q000628:therapy; D015607:Stents