Endovascular treatment for intracranial arterial stenosis

Abstract

Background and Purpose: The stenosis of the major intracranial arteries is a major cause of cerebral stroke. We report our experience of endovascular treatment (percutaneous transluminal angioplasty and stenting ; PTAS) for symptomatic stenosis of major intracranial arteries. Material and methods: Totally 134 cases of symptomatic intracranial arterial stenosis were treated by PTAS at Kyoto Medical Center from 1998. Indication of PTAS was 1)symptomatic stenosis, which was not successfully treated by medication , and 2)more than 60% stenotic lesion shorter than 15mm in length. Balloon angioplasty (BA) was performed first. Stenting was, then, performed in cases of 1) unsuccessful dilatation or arterial dissection after BA and 2)restenosis after BA. Results: Successful dilatation by BA was obtained in 21/26 internal carotid artery (ICA) lesions, in 5/6 middle cerebral artery (MCA) lesions and in 24/29 vertebral artery (VA) lesions (50/61; 82%). Restenosis occurred in 7/26 ICA lesions, 4/6 MCA lesions and 8/29 VA lesions (totally 19/61 lesions; 31%). Successful dilatation by stenting was obtained in 59/60 ICA lesions, 1/1 MCA lesion and 13/15 VA lesions (totally 73/76 lesions; 96%). Restenosis occurred in 5/60 ICA lesions, 1/1 MCA lesion and 1/15 VA lesions (totally 7/76; 9%). Symptomatic complications induced by PTAS occurred in two cases; cerebral stroke and intra cerebral hemorrhage. Stroke recurrence rate after PTAS was 1.1% /year of intracranial ICA lesion and 0.25 % /year of intracranial VA lesion. Conclusions: 1)Symptomatic intracranial arterial stenosis can be treated by PTAS with a low rate of stroke recurrence and complications. 2)Prevention of restenosis after PTAS is a problem to be solved. 3) Therapeutic merit of PTAS for intracranial lesion needs to be examined comparing to the recent aggressive medical therapy.