Outcome of endovascular treatment in symptomatic intracranial vascular stenosis.
OBJECTIVE
The outcome evaluation for the revascularization of intracranial vascular stenoses has not been fully described due to the highly technical nature of the procedure. We report here on the early and late clinical outcomes of angioplasty and/or stenting of symptomatic severe intracranial vascular stenoses at a single institute.


METHODS
Since 1995, we have treated 35 patients with symptomatic intracranial vascular stenosis (more than 70% stenosis, mean stenosis: 78.6%+/-6.2%). Angioplasty (n = 19) was performed for the horizontal segment of the middle cerebral artery (M1) (n = 16) and the basilar artery (BA) (n = 1), the intradural vertebral artery (VA) (n = 1), and the cavernous internal carotid artery (ICA) (n = 1). Stenting (n = 16) was performed for the cavernous or petrous ICAs (n = 9), the intradural VA (n = 3), BA (n = 2), and M1 (n = 2) artery. We assessed the angiographic success (defined as residual stenosis < 50%) rate, the periprocedural complications during the 30-day periprocedural period, the symptomatic recurrence and restenosis during a mean 22-month follow-up (FU) period. The Kaplan-Meier estimate of the cumulative event-free rate of the major cerebrovascular events, i.e. death, stroke or restenosis, was also done.


RESULTS
Angiographic success was achieved in 97% of our patients (34/35). There were four procedure-related complications (11%) including a death and a minor stroke. During the mean 22-month FU, the asymptomatic restenosis rate was 9% and the symptomatic restenosis rate was 6% in the target lesion and 9% in all the vascular territories. The Kaplan-Meier estimate was 70.6% (95% confidence interval = 46.5-94.7) after 33 months of FU.


CONCLUSIONS
In addition to a high angiographic success rate and an acceptable periprocedural complication rate, intracranial angioplasty and/or stenting revealed a relatively low symptomatic recurrence rate. Hemorrhage is a rare, but the physician must aware that potentially fatal periprocedural complications can occur.
Suh
Dae Chul
DC
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. dcsuh@www.amc.seoul.kr
Kim
Sang Joon
SJ
Lee
Duk Hee
DH
Kim
Won
W
Choi
Choog Gon
CG
Lee
Jeong Hyun
JH
Kim
Hyun Jeong
HJ
Kwon
Sun Uck
SU
Kim
Jong Sung
JS
D000328:Adult; D000368:Aged; D017130:Angioplasty; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome
D000925:Anticoagulants