title: Recanalization results after intracranial stenting of atherosclerotic stenoses.
abstract: The purpose of this investigation was to provide a detailed description of the angiographic results after stenting of high-grade intracranial stenosis using balloon-expandable stents. Forty consecutive patients with symptomatic atherosclerotic intracranial stenosis >50% received endovascular treatment by placement of balloon-expandable stents using the concept of slight underdilation and strict avoidance of overdilation. Intra-arterial digital subtraction angiography images before and after stenting in the same projection were reviewed for pre- and post-therapeutic measurement of the degree of stenosis and evaluation of morphologic criteria like plaque coverage, stent apposition, patency of side branches, and signs of dissection or vasospasm. Stenting decreased the mean percentage stenosis from 76.2 (WASID criteria) to 20.8%. Residual stenosis ranged from 0 to 55% with residual stenosis >50% in two of 40 cases. Technical success rate was 95%. There were no major vessel complications, but minor abnormalities like incomplete stent apposition (8/40) or plaque coverage (7/40), incomplete filling of side branches (13/40), and minor dissections after stenting (2/40) were seen. One case with incomplete stent apposition and two cases with side branch compromise were associated with clinical symptoms. In conclusion, intracranial stenting with slight underdilation avoided major vessel complication and created reliable luminal gain. Suboptimal recanalization results were frequently detected and may be the source of neurological complications in individual cases.
authors.affiliation: Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. Stella.Blasel@kgu.de
authors.forename: Stella
authors.initials: S
authors.lastname: Blasel
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Yükzek
authors.forename: Wiebke
authors.initials: W
authors.lastname: Kurre
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.forename: Tobias
authors.initials: T
authors.lastname: Neumann-Haefelin
authors.forename: Elke
authors.initials: E
authors.lastname: Hattingen
authors.forename: Richard
authors.initials: R
authors.lastname: du Mesnil de Rochemont
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D000800:Angioplasty, Balloon / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D017352:Echo-Planar Imaging / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011474:Prosthesis Design; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology