Endovascular reconstruction by means of stent placement in symptomatic intracranial atherosclerotic stenosis.
OBJECTIVE
Patients with intracranial atherosclerosis who fail antithrombotic therapy have a poor prognosis. The high rate of recurrent stroke warrants testing alternative treatments such as intracranial angioplasty.


METHODS
We present our experience in the treatment of 104 patients (age range, 54-82 years; mean age, 67 years) with symptomatic intracranial atherosclerotic stenoses despite medical therapy who underwent stent-assisted angioplasty. Patient records were retrospectively analysed for location and degree of stenosis, regimen of antiplatelet agents, devices used, procedure-related complications and adverse events. Clinical (Modified Rankin Scale) and radiographic outcomes were obtained 24 hours, 1 month and 3-6 months after treatment. Sixty-five lesions (62.5%) were located in the posterior circulation. Mean stenosis was 75.4%.


RESULTS
In all patients, the angiographic degree of stenosis was reduced to less than 30%. One stent was implanted in 66 patients (63%), and two or more in 38 patients (37%). Modified Rankin Scale (mR) was 1-2 in 67.5% of the cases, 3-4 in 25.9%, 5 in 2.8%, 6 in 3.8%. Procedural morbidity was 5.7% and procedural mortality was 3.8%. Angiographic follow-up was available in 58 patients (55.7%) and the restenosis rate was 12.5%.


CONCLUSIONS
In selected patients, endovascular revascularization of intracranial arteries by means of stent-assisted angioplasty is technically feasible, effective and safe.
Lylyk
Pedro
P
Department of Neurosurgery, Endovascular Neurosurgery and Interventional Neuroradiology, ENERI, Clínica Médica Belgrano, Buenos Aires, Argentina. plylyk@lylyk.com.ar
Vila
José F
JF
Miranda
Carlos
C
Ferrario
Angel
A
Musacchio
Alejandro
A
Rüfenacht
Daniel
D
Cohen
José E
JE
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D002533:Cerebral Angiography; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome