Intracranial internal carotid artery stenosis with vulnerable plaques successfully treated by stenting under cerebral protection.
Percutaneous transluminal angioplasty with stenting (PTA/stenting) for intracranial atherosclerotic stenoses is usually performed without any protection devices. We report a unique case of atherothrombotic stenosis with the vulnerable plaque in the cavernous portion of the internal carotid artery (ICA), which was successfully treated by PTA/stenting under cerebral protection with the flow reversal system. A 68-year-old woman presented repetitive transient ischemic attacks in the right ICA territory. Cerebral angiography revealed 80% stenosis in the cavernous portion of the right ICA. High-resolution magnetic resonance imaging (HR-MRI) demonstrated lipid-rich plaques at this lesion. PTA/stenting was performed with a proximal protection device under flow reversal. A filter device captured much amount of atherothrombotic debris with lipid-rich macrophages and leukocytes, which was consistent with HR-MRI findings. Some selected cases of intracranial atherothrombotic ICA stenoses may need endovascular treatment with cerebral protection system. HR-MRI is useful to evaluate plaque characteristics even in the cavernous portion of the ICA.
Hiu
Takeshi
T
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. thiu-nagasaki@umin.ac.jp
Hayashi
Kentaro
K
Kitagawa
Naoki
N
Tsutsumi
Keisuke
K
Horie
Nobutaka
N
Morikawa
Minoru
M
Honda
Masaru
M
Suyama
Kazuhiko
K
Nagata
Izumi
I
D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D008279:Magnetic Resonance Imaging / Q000379:methods; D019736:Prostheses and Implants; D015607:Stents