Preliminary results of endovascular stent-assisted angioplasty for symptomatic middle cerebral artery stenosis.
OBJECTIVE
Stent placement for intracranial atherosclerosis has become an alternative treatment technique; however, stent placement for middle cerebral artery (MCA) stenosis remains a technical and clinical challenge. Our purpose was to assess the feasibility, safety, and effectiveness of stent placement for MCA stenosis.


METHODS
Between May 1998 and August 2003, we performed stent placement for MCA stenosis (more than 50%) in 17 patients and retrospectively analyzed the technical success rate, complications, and outcomes over 10 months.


RESULTS
Stent placement was technically successful in 16 (94.1%) patients and failed in one patient (5.9%), because the stent did not reach the lesion due to carotid artery tortuousity. In 16 patients, postprocedural angiography showed restoration of the normal luminal diameter. Acute in-stent thromboses occurred in nine patients (56.3%) and was lysed with abciximab. The parent artery ruptured in two patients (12.5%): One died from massive subarachnoid hemorrhage, and the other patient received a second stent over the tear site. Stent jumping (distal migration at the time of balloon inflation) occurred in one patient (6.3%) and was solved by implanting a second stent. Periprocedural complications included subacute in-stent thrombosis (n = 1, 6.3%) and minor stroke (n=1, 6.3%); these were relieved with heparin therapy or local thrombolysis. Fifteen patients experienced symptomatic relief or were stable at follow-up. Angiographic follow-up (n=6) revealed no in-stent restenosis.


CONCLUSIONS
Stent placement for symptomatic MCA stenosis was technically feasible and effective in alleviating symptoms and improving cerebral blood flow.
Lee
Tae Hong
TH
Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Republic of Korea.
Kim
Dong Hyun
DH
Lee
Byung-Hee
BH
Kim
Hak Jin
HJ
Choi
Chang Hwa
CH
Park
Kyung Pil
KP
Jung
Dae Soo
DS
Kim
Suk
S
Moon
Tae Yong
TY
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000628:therapy; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000628:therapy*; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000293:injuries; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents