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. 2002 Mar;23(3):430-6.

Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections

Affiliations

Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections

Pedro Lylyk et al. AJNR Am J Neuroradiol. 2002 Mar.

Abstract

Background and purpose: Stent placement has been shown to increase the safety and effectiveness of balloon angioplasty in cervical carotid disease. Here, the authors investigated the feasibility, safety, and short-term outcome of stent-assisted angioplasty for the treatment of intracranial stenoses.

Methods: Thirty-four patients (age range, 12-77 years; mean age, 54 years) with symptomatic intracranial atherosclerotic lesions and dissections that produced stenosis of more than 50% were selected and treated with stents. Eighteen lesions (53%) were located in the anterior circulation, and 16 (47%) were in the vertebrobasilar complex. The mean stenosis was 75%.

Results: At follow up, 21 patients (62%) improved clinically, 11 (32%) remained stable, and the condition of two patients (6%) deteriorated. In all patients, the angiographic degree of stenosis was reduced to less than 30%. In 10 patients (29%), two or more stents were implanted: Two stents were implanted in six patients, and three, in four patients. The transient procedural morbidity rate was 12%, and the transient neurologic morbidity rate was 6%. One patient had hemorrhagic transformation due to reperfusion and died, and another patient had a massive myocardial infarction after 5 months. Twenty patients were followed up with angiography for at least 6 months, and none required repeat angioplasty.

Conclusion: Endovascular revascularization of intracranial arteries by means of stent-assisted angioplasty is technically feasible, effective, and safe in selected patients.

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Figures

F<sc>ig</sc> 1.
Fig 1.
Angioplasty and stent placement in a lesion in the ICA territory. A, Lateral angiogram of the left ICA shows a petrocavernous atherosclerotic lesion. B, Lateral magnified radioscopic view demonstrates the distally placed guidewire, balloon marks, and implanted stent. C, Postoperative angiogram reveals correction of the diseased segment.
F<sc>ig</sc> 2.
Fig 2.
Angioplasty and stent placement in a lesion in the left VA. A, Anteroposterior angiogram of a long stenotic lesion in the left VA. Note that the plaque is centered on the posteroinferior cerebellar artery (PICA) origin. B, Postoperative anteroposterior view shows correction of the stenotic segment. C, Close-up radioscopic oblique view demonstrates three telescoped stents fully deployed.
F<sc>ig</sc> 3.
Fig 3.
Angioplasty and stent placement in a lesion in the basilar artery. A, Anteroposterior angiogram of the right VA shows an atherosclerotic lesion of the basilar artery. B, Immediate postoperative angiogram reveals re storation of the diseased segment. Note the intentional underdilation of the diseased segment. C, Follow-up angiogram obtained after 12 months demonstrates no signs of in-stent stenosis.

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