title: Stenting and angioplasty of small cerebral arteries in symptomatic intracranial atherosclerotic disease.
abstract: BACKGROUND
  Intracranial atherosclerotic disease (ICAD) is a common cause of stroke with a poor natural history despite medical therapy. Few studies have investigated endovascular therapies for the treatment of symptomatic ICAD in distal intracranial arteries. Here, we present the feasibility and safety of balloon angioplasty with and without stenting in patients with medically refractory small artery symptomatic ICAD.
  
  
  METHODS
  Personal logs were reviewed to identify patients who were treated for small artery ICAD (stenosis > 50%) using angioplasty ± stenting. Small cerebral arteries were defined by a diameter ≤ 2 mm or any branch distal to a large intracranial vessel (i.e. distal to ICA, M1, A1, Vertebrobasilar trunk). Patient characteristics, clinical manifestations, treatment, hospital course, and follow up data was collected and analyzed.
  
  
  RESULTS
  Ten patients (12 arteries) were treated with either primary balloon angioplasty (58.3%) or angioplasty with stenting (41.6 %) with 100% technical success rate. Mean pre-treatment stenosis was 79.9% while mean post-treatment stenosis was 19.0%. There were no major peri-procedural complications including symptomatic intracranial hemorrhage or mortality; three cases were complicated by groin hematoma. Patients were followed for a mean total of 18.6 months with only one symptomatic restenosis which was re-treated successfully. All patients had good functional outcome with a mRS of either 0 (80%) or 1 (20%) on follow up.
  
  
  CONCLUSIONS
  In our case series, treatment of symptomatic small artery ICAD with angioplasty ± stenting was safe and effective. These interventions should be considered as an alternative treatment for ICAD patients refractory to medical therapy.
authors.affiliation: Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin ; Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin ; Department of Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
authors.affiliation: Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
authors.forename: Junaid
authors.initials: J
authors.lastname: Kalia
authors.affiliation: Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
authors.forename: Emad
authors.initials: E
authors.lastname: Nourollah-Zadeh
authors.affiliation: Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
authors.forename: Alicia
authors.initials: A
authors.lastname: Castonguay
authors.affiliation: Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin ; Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
authors.forename: Marc
authors.initials: M
authors.lastname: Lazzaro
authors.affiliation: Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin ; Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin ; Department of Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
authors.forename: John
authors.initials: J
authors.lastname: Lynch
authors.affiliation: Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin ; Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin ; Department of Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
authors.forename: Brian-Fred
authors.initials: BF
authors.lastname: Fitzsimmons
keywords: Wingspan; angioplasty; intracranial atherosclerotic disease; small intracranial arteries; stenting