Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease

Abstract

Background and purpose: The safe performance of percutaneous transluminal cerebral angioplasty for intracranial atherosclerotic lesions requires that the risk of complications, such as acute occlusion or symptomatic dissection, and restenosis be reduced. Our purpose was to assess the effectiveness, safety, and short-term arteriographic and clinical outcome of cerebral angioplasty and stenting (CAS) for intracranial vertebrobasilar and distal internal carotid atherosclerotic occlusive lesions.

Methods: Between March 1998 and November 1998, 10 patients with 12 intracranial atherosclerotic lesions of the vertebrobasilar artery and the distal internal carotid artery underwent treatment with flexible balloon-expandable coronary stents.

Results: Although in two of the 10 patients CAS was not successful because of the inability to access the site of arterial stenosis, 10 lesions in eight patients were successfully dilated with stents. No complications occurred during or after the procedure and no neurologic ischemic events or restenoses occurred during the follow-up period.

Conclusion: CAS appears to be a safe and effective means for treating intracranial atherosclerotic occlusive disease, yielding a favorable arteriographic and clinical outcome.

fig 1.

Case 6. A and B, Anteroposterior (A) and lateral (B) views of the left vertebral arteriogram before stent placement reveal a tubular (9.3 mm in length) and moderately eccentric stenosis (62%) (arrow) of the BA and a tubular (8.3 mm in length) and moderately eccentric stenosis (77%) (arrowhead) of the left IVA. Scale (B): 10 mm. C and D, Anteroposterior radiographs show the 3.0-mm gfx stent during deployment in the BA (C) and the 3.5-mm Ranger balloon further expanding the gfx stent in the left IVA (D).

fig 2.

Case 6. A and B, Anteroposterior (A) and lateral (B) views of the left vertebral arteriogram immediately after CAS show sufficient and smooth dilatation of both lesions. C and D, Anteroposterior (C) and lateral (D) views of the left vertebral arteriogram 3 months after CAS show no restenosis of either lesion.

fig 3.

Case 7. A, Lateral view of the right carotid arteriogram before stent placement reveals a tubular (11.4 mm in length) and eccentric stenosis (82%) (arrow) of the distal ICA. Scale: 10 mm. B, Lateral radiograph shows a 4.0-mm NC VIVA balloon catheter further expanding the 3.5-mm Multilink stent in the right distal ICA (arrow). C, Lateral view of the right carotid arteriogram immediately after stent placement shows sufficient and smooth dilatation of the lesion. D, Lateral view of the right carotid arteriogram 3 months after stent placement shows no restenosis.

fig 4.

Changes in the percentage of diameter stenosis on the angiograms obtained before (pre-CAS) and immediately after (post-CAS) treatment and at the 3-month follow-up. There is significant reduction of the stenosis rate between the pre-CAS and immediate post-CAS angiograms (P < .0001, paired Student's t-test)