Intracranial angioplasty and stenting for cerebrovascular disease

Abstract

The use of stent-assisted techniques to manage a variety of cerebrovascular conditions has exploded in recent years. Although the safety of devices is expected to continue to improve, the absence of scientific validation remains an issue in many indications. In posterior circulation arterial disease, considering the absence of valid and reasonable surgical options and the results of the WASID trial, there is widespread consensus that endovascular therapy will become the main option. In anterior circulation intracranial disease, surgical revascularization (EC/IC bypass) may continue to remain an option in selected patients, although it is unclear whether or not randomized clinical trials would be either useful or feasible. The treatment of wide-necked intracranial aneurysms has benefited greatly from the advent of stenting. Intracranial arterial dissections are uncommon and life threatening enough for stenting to remain a major, if not the only, treatment option in many; flexible covered microstents may become the preferred treatment in arterial segments that do not harbor perforators. Concerning the endovascular management of pseudotumor cerebri, as more insight is gained into the epidemiology and the pathophysiology of the disease, it is likely that validation against conventional surgical shunt techniques will be required, at least in subgroups of patients. There is no doubt at this point that large numbers of patients will continue to benefit from the technique. A strong focus on patients' specific needs, a thorough multidisciplinary approach, and continuing efforts in research are necessary to help maintain procedural risks as low as possible.