Provisional stenting for symptomatic intracranial stenosis using a multidisciplinary approach: acute results, unexpected benefit, and one-year outcome.
Percutaneous techniques have dramatically changed our approach to coronary and peripheral revascularization. Intracranial atherosclerosis is a highly morbid disease; however, techniques for revascularization are still in evolution. The authors comprise a multidisciplinary team of neurologists, neuroradiologists, and interventional cardiologists who have collaborated in treating fifteen patients with symptomatic intracranial stenosis who have failed medical therapy. The acute success rate (100%) and one-year freedom from death and stroke (93.4%) using balloon angioplasty and provisional stenting are encouraging. A surprising observation in this patient cohort was that 53% of patients had improvement or resolution of a deficit that was chronic and presumed to be permanent and irreversible. This type of chronic but reversible deficit is termed "brain angina". The background, rationale for a multidisciplinary team, techniques, and preliminary results of intracranial angioplasty with provisional stenting are presented.
Ramee
S R
SR
Department of Cardiology, Ochsner Heart and Vascular Institute, New Orleans, Louisiana, USA. sramee@ochsner.org
Dawson
R
R
McKinley
K L
KL
Felberg
R
R
Collins
T J
TJ
Jenkins
J S
JS
Awaad
M I
MI
White
C J
CJ
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D016893:Carotid Stenosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome