Recent advances in endoluminal revascularization for intracranial atherosclerotic disease.
More than 750,000 strokes occur annually in the United States. Of these, 8-10% are due to intracranial atherosclerosis. Less than 50% of patients with strokes from intracranial atherosclerosis will have a transient ischemic attack. For those patients with symptomatic intracranial atherosclerosis, the prognosis is poor; and the recent Warfarin-Aspirin Symptomatic Intracranial Stenosis (WASID) trial results have demonstrated the high risk of warfarin without clear benefit. Intracranial angioplasty and stenting is emerging as a viable and effective treatment alternative for patients with symptomatic intracranial stenosis. Advances in stent design, endovascular wires, and catheters and balloons are allowing endovascular surgeons to safely treat intracranial atherosclerosis. Wider clinical experience has led to refinement of patient selection and endoluminal techniques. Drug eluting-stents have the promise of decreasing the risk of restenosis. In this review, the most recent clinical, laboratory, and technical details for the treatment of intracranial angioplasty and stenting are discussed.
Sauvageau
Eric
E
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, New York 14209-1194, USA.
Ecker
Robert D
RD
Levy
Elad I
EI
Hanel
Ricardo A
RA
Guterman
Lee R
LR
Hopkins
L Nelson
LN
D004691:Endarterectomy / Q000379:methods* / Q000639:trends; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000601:surgery*; D018579:Patient Selection; D015607:Stents