Indications and applications of arterial stents for stroke prevention in atherosclerotic intracranial stenosis.
Intracranial stenosis accounts for 8-10% of all ischemic strokes in North America, a frequency slightly less than that of extracranial carotid stenosis. Among patients presenting with transient ischemic attack or stroke due to intracranial stenosis, the risk of recurrent stroke in the first year after initial symptoms is about 14%. Those with high-risk features (recent stroke and severe stenosis) have up to a 23% rate of recurrent stroke in the year after their initial event. Angioplasty with stenting has emerged as a potential treatment strategy, particularly in high-risk patients, although evidence is currently limited to uncontrolled prospective trials and retrospective case series. In this article, we critically review the clinical results supporting the use of stenting and highlight some key considerations in the application of this technology, including patient selection, procedural management, technical issues, and risk factors for complications and in-stent restenosis.
Fields
Jeremy D
JD
Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR-127, Portland, OR 97239, USA. fieldsje@ohsu.edu
Liu
Kenneth C
KC
Barnwell
Stanley L
SL
Clark
Wayne M
WM
Lutsep
Helmi L
HL
D000800:Angioplasty, Balloon; D002339:Carotid Arteries / Q000473:pathology* / Q000601:surgery; D016893:Carotid Stenosis / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D054855:Drug-Eluting Stents; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D055502:Secondary Prevention
D010975:Platelet Aggregation Inhibitors