title: The modified Bose method for the endovascular treatment of intracranial atherosclerotic arterial stenoses using the Enterprise stent.
abstract: BACKGROUND
  Balloon dilatation and deployment of a self-expanding stent is a safe treatment for intracranial atherosclerotic stenoses. The significant recurrence rate might be related to the high radial force of the Wingspan stent.
  
  
  OBJECTIVE
  To evaluate the procedural safety and stenosis recurrence rate by the use of a stent with reduced radial force (Enterprise).
  
  
  METHODS
  Two hundred nine atherosclerotic stenoses (189 patients) were treated (median age, 68 years; 132 male) in a single center. Lesion locations included internal carotid artery (n = 27), middle cerebral artery (n = 62), vertebral artery (n = 64), basilar artery (n = 55), and posterior cerebral artery (n = 1). Pre- and postmedication included acetylsalicylic acid and Clopidogrel for at least 12 months. Preprocedural and follow-up examinations included magnetic resonance imaging (MRI), neurological assessment, and digital subtraction angiography (6, 12, 26, and 52 weeks). Data registry included age, sex, normal vessel diameter, degree of stenosis, residual stenosis after stent, minimal in-stent diameter, and occurrence of ischemic symptoms during follow-up.
  
  
  RESULTS
  Median pre- and postprocedural stenosis rate was 65.4 ± 1% vs 25.1 ± 1%. Technical success rate was 100%. Major procedural complications occurred in 16 patients (8.1%). Combined neurological morbidity and mortality rate at 30 days was 2 patients (0.9%). In 174 stenoses (83%) angiographic follow-up was obtained (mean, 10.2 months). A restenosis (>50%) was observed in 43 (24.7%) cases after 4.2 months (mean) with 4 (9.3%) symptomatic lesions. Incidence of recurrent ischemia related to the stented artery was 2.2% during 10.2 months of mean follow-up.
  
  
  CONCLUSIONS
  Undersized balloon angioplasty and deployment of an Enterprise stent is safe and effective for intracranial stenoses. Follow-up results were equal to or better than those reported for bare-metal balloon-expandable or self-expanding stents and yielded excellent protection from recurrent ischemia.
authors.affiliation: Klinik für Neuroradiologie, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Vajda
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schmid
authors.forename: Thomas
authors.initials: T
authors.lastname: Güthe
authors.forename: Christoph
authors.initials: C
authors.lastname: Klötzsch
authors.forename: Alfred
authors.initials: A
authors.lastname: Lindner
authors.forename: Ludwig
authors.initials: L
authors.lastname: Niehaus
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sperber
authors.forename: Jan
authors.initials: J
authors.lastname: Peters
authors.forename: Guy
authors.initials: G
authors.lastname: Arnold
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Bäzner
authors.forename: Hans
authors.initials: H
authors.lastname: Henkes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D000800:Angioplasty, Balloon / Q000295:instrumentation* / Q000379:methods*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015607:Stents; D016896:Treatment Outcome