Provisional stenting for symptomatic intracranial stenosis using a multidisciplinary approach: Acute results, unexpected benefit, and one‐year outcome

Abstract

Percutaneous techniques have dramatically changed our approach to coronary and peripheral revascularization. Intracranial atherosclerosis is a highly morbid disease; however, techniques for revascularization are still in evolution. The authors comprise a multidisciplinary team of neurologists, neuroradiologists, and interventional cardiologists who have collaborated in treating fifteen patients with symptomatic intracranial stenosis who have failed medical therapy. The acute success rate (100%) and one-year freedom from death and stroke (93.4%) using balloon angioplasty and provisional stenting are encouraging. A surprising observation in this patient cohort was that 53% of patients had improvement or resolution of a deficit that was chronic and presumed to be permanent and irreversible. This type of chronic but reversible deficit is termed "brain angina". The background, rationale for a multidisciplinary team, techniques, and preliminary results of intracranial angioplasty with provisional stenting are presented.

Need of Conscious Sedation or General Anesthesia during NeuroInterventional Procedures

“…Emergent conversion to general anesthesia was not associated with worse outcomes than those observed in planned general anesthesia. This is similar to Ramee et al 8 Few anesthetists prefer to use conscious sedation as they help in reduction of hospital cost by avoiding use of general anesthesia. In addition to the procedural costs of anesthetic agents, anesthesia personnel, and mechanical ventilation, considerable expenses can be avoided with reduction of hospital and ICU stays.…”

Intracranial revascularization therapy: Angioplasty and stenting

“…Additionally, hyperperfusion syndrome with hemorrhage has been reported after successful middle cerebral artery angioplasty [40] and documented in a larger experience that included 140 patients treated for [43], and Lylyk et al [44]. )…”

Acute Stroke Treatment

“…Rather than continuing to fight "turf wars" between specialties, it is time for interventionalists to work together on multispecialty stroke teams led by stroke neurologists (18). American medicine cannot afford to allow political infighting to constrain the number of willing interventionalists from participating in acute stroke care.…”