Primary stenting of intracranial atherosclerotic stenoses.
OBJECTIVE
To determine the feasibility and safety of stenting intracranial atherosclerotic stenoses.


METHODS
In 12 patients the results of primary intracranial stenting were evaluated retrospectively. Patient ages ranged from 49 to 79 years (mean 64 years). Six patients presented with stenoses in the anterior circulation, and six had stenosis in the posterior circulation. One patient presented with extra- and intracranial tandem stenosis of the left internal carotid artery. Three patients presented with acute basilar thrombosis, caused by high-grade basilar stenoses.


RESULTS
Intracranial stenoses were successfully stented in 11 of 12 patients. In one patient the stent could not be advanced over the carotid siphon to reach the stenosis of the ophthalmic internal carotid artery. Follow-up digital subtraction angiographic studies were obtained in two patients who had presented with new neurologic signs or symptoms. In both cases the angiogram did not show any relevant stenotic endothelial hyperplasia. In one patient, after local thrombolysis the stenosis turned out to be so narrow that balloon angioplasty had to be performed before stent deployment. All three patients treated for stenosis-related basilar thrombosis died due to brainstem infarction that had ensued before the intervention.


CONCLUSIONS
Prophylactic primary stenting of intracranial stenoses of the anterior or posterior cerebral circulation can be performed with a low complication rate; technical problems such as stent flexibility must still be solved. Local thrombolysis followed by stenting in stenosis-related thrombotic occlusion is technically possible.
Straube
T
T
Section of Neuroradiology, Department of Neurosurgery, University of Kiel, Weimarer Strasse 8, 24106 Kiel, Germany. straubetwi@aol.com
Stingele
Robert
R
Jansen
Olav
O
D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D020771:Anterior Cerebral Artery / Q000473:pathology; D001488:Basilar Artery / Q000473:pathology; D020526:Brain Stem Infarctions / Q000209:etiology; D002343:Carotid Artery, Internal / Q000473:pathology; D016893:Carotid Stenosis / Q000628:therapy; D002423:Cause of Death; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000473:pathology; D012189:Retrospective Studies; D012449:Safety; D015607:Stents; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy; D017585:Ultrasonography, Doppler, Transcranial