Endovascular Therapy of Symptomatic Intracranial Stenosis in Patients With Impaired Regional Cerebral Blood Flow or Failure of Medical Therapy

The results demonstrate the technical feasibility and satisfactory success rates of stent angioplasty in intracranial atherosclerotic stenoses. The procedural success rate was 98% and the overall rate of adverse events was 20.4%. The rate of adverse events was high in unstable patients (87.5%) treated without antiplatelet premedication, especially in the setting of an acute stroke. In stable patients the rate of adverse events was much lower (8.3%). Future development of dedicated stents and a better understanding of factors that predispose to restenosis may help to further decrease the rate of periprocedural and postprocedural adverse events thus helping to improve both short-term and long-term outcome after intracranial stent angioplasty.

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“…In such cases, rescue angioplasty with or without stenting may prevent reocclusion in a stenotic artery and permit distal infusion of thrombolytic agents [9]. In addition, mechanical disruption of an occlusive thrombus using a mechanical retrieval device or balloon angioplasty may fragment the thrombus and present a greater surface area for thrombolytic agent binding and may improve the effi cacy of chemical thrombolysis [14].…”

Section: Indicationsmentioning

confidence: 99%

“…The rate of stroke and death from intracranial angioplasty and stenting is 9.5% [12]. The rate of restenosis is 32.4% to 35%, of which 50% become symptomatic [13,14]. The option of conventional surgical intervention fell into disfavor following the EC/IC bypass study, which demonstrated no advantage for EC-IC bypass and greater rates of fatal and non-fatal strokes [15].…”

Section: Introductionmentioning

confidence: 99%

The Technique of Angioplasty and Stent Placement in Acute Ischemic Stroke Therapy

Khan

2011

J Neurol Res

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Stroke is a second leading cause of death and disability in both developed and developing countries. 8-10% of ischemic strokes are caused by stenosis consequent to intracranial atherosclerotic disease. A growing body of evidence suggests that an aggressive approach may be indicated for patients with intracranial stenosis in the face of persistent symptoms despite adequate medical management, as the incidence of stroke or death in such situations is greater than 50%. By comparison, patients who fail medical management and intravenous thrombolysis, the risk of neurological complications from angioplasty, stenting, or both together, has been reported as 0% to 28%. The technical success rates for immediate, delayed and rescue angioplasty are very good (71-100%). Stenting is an option following angioplasty of a stenosed vessel and in case of embolic strokes where angioplasty alone produces only a temporary recanalizing effect. The rate of stroke and death from intracranial angioplasty and stenting is up to 10%, which is favorable when taking into consideration the risks of failed medical management. Currently, endovascular intervention is usually undertaken when medical management fails. Studies demonstrate angioplasty and stenting to be safe and effective. Technical success rate of angioplasty and stenting is up to 98-99%. In this review, we address the indications for intracranial angioplasty and stenting and provide a reasonably detailed account for readers who perform these procedures. We will also address the potential complications that might arise during intervention and provide practical tips towards successful resolution.

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Endovascular Therapy of Symptomatic Intracranial Stenosis in Patients With Impaired Regional Cerebral Blood Flow or Failure of Medical Therapy

Abstract: BACKGROUND AND PURPOSE: Symptomatic intracranial stenoses have a high risk for a recurrent stroke if treated medically. Although angioplasty and stent placement are proposed treatment options, data on longer-term outcome are limited.

Cited by 10 publications

References 31 publications

Stenting of acute and subacute intracranial vertebrobasilar arterial occlusive lesions

Stenting of acute and subacute intracranial vertebrobasilar arterial occlusive lesions

Stent Angioplasty of Intracranial Stenosis

The Technique of Angioplasty and Stent Placement in Acute Ischemic Stroke Therapy

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