Initial experience with angioplasty of symptomatic M2 MCA atheromatous lesions

Hussain, Muhammad Shazam; Cheng-Ching, Esteban; Bain, Mark; Spiotta, Alejandro M; Sivapatham, Thinesh; Hui, Ferdinand; Moskowitz, S; Gupta, Rishi

doi:10.1136/jnis.2009.001818

Cited by 1 publication

(4 citation statements)

References 6 publications

(6 reference statements)

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“…This is comparable with other small artery ICAD studies with reported success rates of 98.1 to 100%, with the only technical difficulty due to failure of wingspan stent deployment in a tortuous M2 lesion 14-17 . Furthermore, there were no peri-procedural complications in our patients, which is also similar to previously published case series (Table 2).…”

Section: Discussionsupporting

confidence: 88%

“…The patient was re-treated with PTAS with no further instent restenosis (ISR) during follow up. In other small ICAD publications, the overall restenosis rate for primary angioplasty was 40.0% (all symptomatic) and 27.7% for PTAS (only 5.6% symptomatic) 14-17 . Studies examining large artery ICAD have stated variable ISR rate for the Wingspan system.…”

Section: Discussionmentioning

confidence: 81%

“…Unfortunately, functional outcome has not been consistently reported in other small artery ICAD studies 14-17 .…”

Section: Discussionmentioning

confidence: 91%

“…Recently SAMMPRIS, the only randomized controlled trial for endovascular treatment of ICAD, demonstrated the superiority of aggressive medical therapy over PTAS, as stroke recurrence occurred within the first year in 12.2 % versus 20.9% of patient in the medical and PTAS arms, respectively. SAMMPRIS studied ICAD only in large intracranial arteries (2 to 4.5 mm); unfortunately, small artery ICAD has not been studied extensively and endovascular treatment may be a valuable alternative in medically refractory patients as large and small artery ICAD could possibly represent two distinct entities, with different natural history and response to medical and interventional treatments (Table 2) 14-17 .…”

Section: Discussionmentioning

confidence: 99%

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Stenting and Angioplasty of Small Cerebral Arteries in Symptomatic Intracranial Atherosclerotic Disease

et al. 2013

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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 and/or stenting. Small cerebral arteries were defined by a diameter of ≤2 mm or any branch distal to a large intracranial vessel (i.e. distal to the internal carotid artery, M1, A1, or vertebrobasilar trunk). Patient characteristics, clinical manifestations, treatment, hospital course, and follow-up data were collected and analyzed. Results: Ten patients (12 arteries) were treated with either primary balloon angioplasty (58.3%) or angioplasty with stenting (41.6%) with a 100% technical success rate. Mean pretreatment stenosis was 79.9%, while mean posttreatment stenosis was 19.0%. There were no major periprocedural complications, including symptomatic intracranial hemorrhage or mortality; 3 cases were complicated by groin hematoma. Patients were followed for a mean total of 18.6 months with only 1 symptomatic restenosis which was retreated successfully. All patients had good functional outcome with a modified Rankin Scale of either 0 (80%) or 1 (20%) on follow-up. Conclusion: In our case series, treatment of symptomatic small-artery ICAD with angioplasty and/or stenting was safe and effective. These interventions should be considered as an alternative treatment for ICAD patients refractory to medical therapy.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 81%

“…Unfortunately, functional outcome has not been consistently reported in other small artery ICAD studies 14-17 .…”

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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