Utilization of self-expanding stents in the treatment of intracranial atherosclerotic disease in the distal small cerebral vessels.
BACKGROUND
Previously, endovascular treatment of stenosis related to intracranial atherosclerosis (ICAD) involving arteries measuring less than 2 mm in diameter was limited. To our knowledge, there are no reports in the literature addressing stent placement for treatment of stenosis in arteries of this size.


METHODS
Four patients aged 33 to 80 years (mean 57.5 years) with medically refractory ICAD underwent angioplasty and stenting of small (<2 mm) distal intracerebral arteries. Vessel location and length of follow-up were anterior cerebral artery (ACA) A1 segment (5 months), ACA A2 segment (18 months), middle cerebral artery M1 segment (18 months), and posterior cerebral artery P1 segment (8 months) with vessel calibers ranging from 1.2 to 1.8 mm. Clinical and imaging follow-up ranged from 5 to 18 months.


RESULTS
All procedures were successfully performed without complications. Follow-up out to 18 months demonstrated one vessel that went on to occlusion while the other stented vessel segments remained patent. One patient died 8 months after stenting, but the death was not related to neurological disease. The remaining patients experienced resolution of the presenting symptomatology and remained asymptomatic throughout follow-up.


CONCLUSIONS
In this small series, stenoses of distal (<2 mm) cerebral arteries were amenable to treatment using new self-expanding stents. We safely and successfully treated four arteries smaller than 2 mm in diameter with newer self-expanding stents. All patients remained clinically asymptomatic. One stent occluded at 5 months and the others remained patent during follow-up. Longer term clinical follow-up is required to determine the durability and viability of this therapy.
Turk
Aquilla S
AS
Department of Neurosurgery, University of Wisconsin Hospital and Clinics, 600 Highland Ave., Madison, WI, USA. as.turk@hosp.wisc.edu
Ahmed
Azam
A
Niemann
David B
DB
Aagaard-Kienitz
Beverly
B
Brooks
Nathaniel
N
Levine
Ross L
RL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents