title: Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis.
abstract: BACKGROUND
  Endovascular revascularization for intracranial atherosclerotic stenoses is being increasingly performed at major medical centers and has been reported to be technically feasible and safe. The authors report their experience with patients who underwent such a procedure for impending stroke and neurologic instability.
  
  
  METHODS
  All 18 patients (21 intracranial lesions) treated between 1997 and 2002 at the authors' institution with endovascular revascularization were retrospectively reviewed. Each patient had failed maximal medical therapy and was thought to be at high risk for an imminent stroke.
  
  
  RESULTS
  Endovascular revascularization was performed on eight distal internal carotid artery lesions, six middle cerebral artery lesions, four intracranial vertebral artery lesions, and three basilar artery lesions. Recanalization was complete in 5 arteries (Thrombolysis in Myocardial Infarction [TIMI] Grade III), partial in 14 arteries (TIMI Grade II), and complete occlusion (TIMI 0) developed in 1 artery. In a patient with a tight basilar stenosis, no angioplasty could be performed because of the inability to cross the stenosis with the guidewire. Major periprocedural complications occurred in 9 (50%) patients: intracranial hemorrhage in 3 (17%), disabling ischemic stroke in 2 (11%), and major extracranial hemorrhage in 4 (22%). Three patients died: one from intracerebral hemorrhage and two from cardiorespiratory failure.
  
  
  CONCLUSIONS
  Endovascular revascularization of intracranial vessels is technically feasible and may be performed successfully. However, periprocedural complication and fatality rates in neurologically unstable patients are high. The results suggest that patient selection, procedure timing, and periprocedural medical management are critical factors to reduce periprocedural morbidity and mortality.
authors.affiliation: Department of Neurology, New York Presbyterian Hospital, Columbia University, New York, NY 10032, USA.
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.forename: H C
authors.initials: HC
authors.lastname: Schumacher
authors.forename: S
authors.initials: S
authors.lastname: Mangla
authors.forename: P M
authors.initials: PM
authors.lastname: Meyers
authors.forename: H
authors.initials: H
authors.lastname: Duong
authors.forename: A G
authors.initials: AG
authors.lastname: Khandji
authors.forename: R S
authors.initials: RS
authors.lastname: Marshall
authors.forename: J P
authors.initials: JP
authors.lastname: Mohr
authors.forename: J
authors.initials: J
authors.lastname: Pile-Spellman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D002545:Brain Ischemia / Q000209:etiology / Q000601:surgery; D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000209:etiology; D002544:Cerebral Infarction / Q000209:etiology / Q000517:prevention & control; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000601:surgery*; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000601:surgery*