title: Percutaneous transluminal angioplasty and stenting for severe stenosis of the intracranial extradural internal carotid artery causing transient ischemic attack or minor stroke.
abstract: The purpose of this study is to assess the technical feasibility and clinical efficacy of percutaneous transluminal angioplasty and stenting (PTAS) for symptomatic stenosis of the intracranial extradural (petrous and cavernous) internal carotid artery (ICA).Review of medical records identified 26 consecutive patients who underwent PTAS using a balloon-expandable coronary stent (n = 15, 57.7%) or a Wingspan self-expandable stent (n = 11, 42.3%) for treatment of severe stenosis (>70%) involving the intracranial extradural ICA. The inclusion criteria were transient ischemic attack with an ABCD(2) score of ≥3 (n = 12, 46.2%) or minor stroke with an NIHSS score of ≤4 (n = 14, 53.8%). Technical success rates, complications, and angiographic and clinical outcomes were analyzed retrospectively.PTAS was technically successful in all patients. The mean stenosis ratio decreased from 77.1% to 10.0% immediately after PTAS. The overall incidence of procedural complications was 23.1%, and the postoperative permanent morbidity/mortality rate was 7.7%. A total of 22 patients were tracked over an average period of 29.9 months. During the observation period, 20 patients (90.9%) had no further cerebrovascular events and stroke recurrence occurred in two patients (9.1%), resulting in an annual stroke risk of 3.7%. Two cases (11.1%) of significant in-stent restenosis (>50%) were found on follow-up angiography (n = 18).PTAS for severe stenosis (>70%) involving the intracranial extradural ICA showed a good technical feasibility and favorable clinical outcome in patients with transient ischemic attack or minor stroke.
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Korea.
authors.forename: Jun Kyeung
authors.initials: JK
authors.lastname: Ko
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Korea.
authors.forename: Chang Hwa
authors.initials: CH
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Korea.
authors.forename: Seung Heon
authors.initials: SH
authors.lastname: Cha
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Korea.
authors.forename: Byung Kwan
authors.initials: BK
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Korea.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Cho
authors.affiliation: Department of Neurology, Medical Research Institute, Pusan National University Hospital, Korea.
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Kang
authors.affiliation: Department of Neurology, Medical Research Institute, Pusan National University Hospital, Korea.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Sung
authors.affiliation: Department of Neurology, Medical Research Institute, Pusan National University Hospital, Korea.
authors.forename: Han Jin
authors.initials: HJ
authors.lastname: Cho
authors.affiliation: Department of Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Korea drcello@lycos.co.kr.
authors.forename: Tae Hong
authors.initials: TH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000379:methods*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D016896:Treatment Outcome
keywords: Stents; angioplasty; carotid stenosis; stroke; transient ischemic attack