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Intracranial angioplasty and stenting for cerebral atherosclerosis: new treatments for stroke are needed!

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Abstract

Introduction

Intracranial atherosclerosis is a common cause of stroke.

Intracranial angioplasty and stent revascularization

Recent technological developments offer improved methods for endovascular revascularization of symptomatic and asymptomatic cerebral artery stenosis. Identification of appropriate patients remains a diagnostic challenge, and our knowledge about the natural history of the disease remains limited.

Recommendations

At this time, patients with significant intracranial stenosis should receive counseling on the benefits and risks of revascularization therapy. Ultimately, determination of which patients should undergo revascularization procedures will require carefully planned, randomized clinical trials.

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References

  1. American Heart Association (2004) Heart disease and stroke statistics – 2004 update. American Heart Association, Dallas, TX

  2. Sacco RL, Kargman DE, Gu Q, Zamanillo MC (1995) Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan stroke study. Stroke 26(1):14–20

    PubMed  CAS  Google Scholar 

  3. Segura T, Serena J, Castellanos M, Teruel J, Vilar C, Davalos A (2001) Embolism in acute middle cerebral artery stenosis. Neurology 56(4):497–501

    PubMed  CAS  Google Scholar 

  4. Wityk RJ, Lehman D, Klag M, Coresh J, Ahn H, Litt B (1996) Race and sex differences in the distribution of cerebral atherosclerosis. Stroke 27(11):1974–1980

    PubMed  CAS  Google Scholar 

  5. Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Silliman S, Pessin MS, Weichel E, Sila CA, Furlan AJ, et al (1995) The Warfarin-aspirin symptomatic intracranial disease study. Neurology 45(8):1488–1493

    PubMed  CAS  Google Scholar 

  6. Thijs VN, Albers GW (2000) Symptomatic intracranial atherosclerosis: outcome of patients who fail antithrombotic therapy. Neurology 55(4):490–497

    PubMed  CAS  Google Scholar 

  7. Chimowitz M, Lynn M, Howlett-Smith H, Stern B, Hertzberg VS, FrankelM (2004) Warfarin-aspirin symptomatic intracranial disease (WASID) trial: final results (abstract). Stroke 35(1):235

  8. EC/IC Bypass Study Group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313(19):1191–1200

    Article  Google Scholar 

  9. Rundek T, Elkind MS, Chen X (1998) Increased early stroke recurrence among patients with extracranial and intracranial atherosclerosis: Northern Manhattan stroke study. Neurology 50 [Suppl 4]:A75

    Google Scholar 

  10. Caplan LR, Gorelick PB, Hier DB (1986) Race, sex and occlusive cerebrovascular disease: a review. Stroke 17(4):648–655

    PubMed  CAS  Google Scholar 

  11. Ingall TJ, Homer D, Baker HL Jr, Kottke BA, O’Fallon WM, Whisnant JP (1991) Predictors of intracranial carotid artery atherosclerosis. Duration of cigarette smoking and hypertension are more powerful than serum lipid levels. Arch Neurol 48(7):687–691

    PubMed  CAS  Google Scholar 

  12. Caplan LR (2004) Advances in stroke research: basic science, treatment, and clinical trial outcomes. Rev Neurol Dis 2(1):91–94

    Google Scholar 

  13. Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, Kistler JP, Albers GW, Pettigrew LC, Adams HP Jr, Jackson CM, Pullicino P (2001) A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 345(20):1444–1451

    Article  PubMed  CAS  Google Scholar 

  14. SSYLVIA Study Investigators (2004) Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA): study results. Stroke 35(6):1388–1392

    Article  Google Scholar 

  15. Higashida RT, Hieshima GB, Tsai FY, Halbach VV, Norman D, Newton TH (1987) Transluminal angioplasty of the vertebral and basilar artery. AJNR Am J Neuroradiol 8(5):745–749

    PubMed  CAS  Google Scholar 

  16. Higashida RT, Tsai FY, Halbach VV, Dowd CF, Smith T, Fraser K, Hieshima GB (1993) Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries. J Neurosurg 78(2):192–198

    PubMed  CAS  Google Scholar 

  17. Terada T, Higashida RT, Halbach VV, Dowd CF, Nakai E, Yokote H, Itakura T, Hieshima GB (1996) Transluminal angioplasty for arteriosclerotic disease of the distal vertebral and basilar arteries. J Neurol Neurosurg Psychiatry 60(4):377–381

    Article  PubMed  CAS  Google Scholar 

  18. Higashida RT, Tsai FY, Halbach VV, Dowd CF, Hieshima GB (1996) Transluminal angioplasty, thrombolysis, and stenting for extracranial and intracranial cerebral vascular disease. J Interv Cardiol 9(3):245–256

    Article  Google Scholar 

  19. Phatouros CC, Higashida RT, Malek AM, Smith WS, Mully TW, DeArmond SJ, Dowd CF, Halbach VV (1999) Endovascular stenting of an acutely thrombosed basilar artery: technical case report and review of the literature. Neurosurgery 44(3):667–673

    Article  PubMed  CAS  Google Scholar 

  20. Malek AM, Higashida RT, Phatouros CC, Lempert TE, Meyers PM, Gress DR, Dowd CF, Halbach VV (1999) Treatment of posterior circulation ischemia with extracranial percutaneous balloon angioplasty and stent placement. Stroke 30(10):2073–2085

    PubMed  CAS  Google Scholar 

  21. Phatouros CC, Lefler JE, Higashida RT, Meyers PM, Malek AM, Dowd CF, Halbach VV (2000) Primary stenting for high-grade basilar artery stenosis. AJNR Am J Neuroradiol 21(9):1744–1749

    PubMed  CAS  Google Scholar 

  22. Gress DR, Smith WS, Dowd CF, Van Halbach V, Finley RJ, Higashida RT (2002) Angioplasty for intracranial symptomatic vertebrobasilar ischemia. Neurosurgery 51(1):23–27; discussion 27–29

    Article  PubMed  Google Scholar 

  23. Schumacher HC, Khaw AV, Meyers PM, Gupta R, Higashida RT (2004) Intracranial angioplasty and stent placement for cerebral atherosclerosis. J Vasc Interv Radiol 15(1 Pt 2):S123–S132

    PubMed  Google Scholar 

  24. Lopes DK, Ringer AJ, Boulos AS, Qureshi AI, Lieber BB, Guterman LR, Hopkins LN (2003) Fate of branch arteries after intracranial stenting. Neurosurgery 52(6):1275–1278; discussion 1278–1279

    Article  PubMed  Google Scholar 

  25. Levy EI, Horowitz MB, Koebbe CJ, Jungreis CC, Pride GL, Dutton K, Purdy PD (2001) Transluminal stent-assisted angioplasty of the intracranial vertebrobasilar system for medically refractory, posterior circulation ischemia: early results. Neurosurgery 48(6):1215–1221; discussion 1221–1223

    Article  PubMed  CAS  Google Scholar 

  26. Qureshi AI, Ziai WC, Yahia AM, Mohammad Y, Sen S, Agarwal P, Zaidat OO, Suarez JI, Wityk RJ (2003) Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: a multicenter study. Neurosurgery 52(5):1033–1039; discussion 1039-1040

    Article  PubMed  Google Scholar 

  27. Gomez CR, Orr SC (2001) Angioplasty and stenting for primary treatment of intracranial arterial stenoses. Arch Neurol 58(10):1687–1690

    Article  PubMed  CAS  Google Scholar 

  28. Mori T, Kazita K, Chokyu K, Mima T, Mori K (2000) Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease. AJNR Am J Neuroradiol 21(2):249–254

    PubMed  CAS  Google Scholar 

  29. Nahser HC, Henkes H, Weber W, Berg-Dammer E, Yousry TA, Kuhne D (2000) Intracranial vertebrobasilar stenosis: angioplasty and follow-up. AJNR Am J Neuroradiol 21(7):1293–1301

    PubMed  CAS  Google Scholar 

  30. Gomez CR, Misra VK, Liu MW, Wadlington VR, Terry JB, Tulyapronchote R, Campbell MS (2000) Elective stenting of symptomatic basilar artery stenosis. Stroke 31(1):95–99

    PubMed  CAS  Google Scholar 

  31. Marks MP, Marcellus M, Norbash AM, Steinberg GK, Tong D, Albers GW (1999) Outcome of angioplasty for atherosclerotic intracranial stenosis. Stroke 30(5):1065–1069

    PubMed  CAS  Google Scholar 

  32. Connors JJ 3rd, Wojak JC (1999) Percutaneous transluminal angioplasty for intracranial atherosclerotic lesions: evolution of technique and short-term results. J Neurosurg 91(3):415–423

    Article  PubMed  Google Scholar 

  33. Yu W, Smith WS, Singh V, Ko NU, Cullen SP, Dowd CF, Halbach VV, Higashida RT (2005) Long-term outcome of endovascular stenting for symptomatic basilar artery stenosis. Neurology 64(6):1055–1057

    PubMed  CAS  Google Scholar 

  34. Henkes H, Miloslavski E, Lowens S, Reinartz J, Liebig T, Kuhne D (2005) Treatment of intracranial atherosclerotic stenoses with balloon dilatation and self-expanding stent deployment (WingSpan). Neuroradiology 47(3):222–228

    Article  PubMed  CAS  Google Scholar 

  35. Bose A (2005) The Wingspan Study. Presented at the American Society of Neuroradiology 43rd Annual Meeting, Toronto, Canada, 21–27 May

  36. Derdeyn CP, Grubb RL Jr, Powers WJ (1999) Cerebral hemodynamic impairment: methods of measurement and association with stroke risk. Neurology 53(2):251–259

    PubMed  CAS  Google Scholar 

  37. Naritomi H, Sawada T, Kuriyama Y, Kinugawa H, Kaneko T, Takamiya M (1985) Effect of chronic middle cerebral artery stenosis on the local cerebral hemodynamics. Stroke 16(2):214–219

    PubMed  CAS  Google Scholar 

  38. Grubb RL Jr, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Spitznagel EL, Powers WJ (1998) Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA 280(12):1055–1060

    Article  PubMed  Google Scholar 

  39. Constantinides P (1967) Pathogenesis of cerebral artery thrombosis in man. Arch Pathol 83(5):422–428

    PubMed  CAS  Google Scholar 

  40. Caplan LR (1989) Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology 39(9):1246–1250

    PubMed  CAS  Google Scholar 

  41. Bogousslavsky J, Barnett HJ, Fox AJ, Hachinski VC, Taylor W (1986) Atherosclerotic disease of the middle cerebral artery. Stroke 17(6):1112–1120

    PubMed  CAS  Google Scholar 

  42. Yanagihara T, Piepgras DG, Klass DW (1985) Repetitive involuntary movement associated with episodic cerebral ischemia. Ann Neurol 18(2):244–250

    Article  PubMed  CAS  Google Scholar 

  43. Tatemichi TK, Young WL, Prohovnik I, Gitelman DR, Correll JW, Mohr JP (1990) Perfusion insufficiency in limb-shaking transient ischemic attacks. Stroke 21(2):341–347

    PubMed  CAS  Google Scholar 

  44. Zaidat OO, Werz MA, Landis DM, Selman W (1999) Orthostatic limb shaking from carotid hypoperfusion. Neurology 53(3):650–651

    PubMed  CAS  Google Scholar 

  45. Mull M, Schwarz M, Thron A (1997) Cerebral hemispheric low-flow infarcts in arterial occlusive disease. Lesion patterns and angiomorphological conditions. Stroke 28(1):118–123

    PubMed  CAS  Google Scholar 

  46. Lythgoe DJ, Ostergaard L, William SC, Cluckie A, Buxton-Thomas M, Simmons A, Markus HS (2000) Quantitative perfusion imaging in carotid artery stenosis using dynamic susceptibility contrast-enhanced magnetic resonance imaging. Magn Reson Imaging 18(1):1–11

    Article  PubMed  CAS  Google Scholar 

  47. Kim JH, Lee SJ, Shin T, Kang KH, Choi PY, Kim JH, Gong JC, Choi NC, Lim BH (2000) Correlative assessment of hemodynamic parameters obtained with T2*-weighted perfusion MR imaging and SPECT in symptomatic carotid artery occlusion. AJNR Am J Neuroradiol 21(8):1450–1456

    PubMed  CAS  Google Scholar 

  48. Kikuchi K, Murase K, Miki H, Kikuchi T, Sugawara Y, Mochizuki T, Ikezoe J, Ohue S (2001) Measurement of cerebral hemodynamics with perfusion-weighted MR imaging: comparison with pre- and post-acetazolamide 133Xe-SPECT in occlusive carotid disease. AJNR Am J Neuroradiol 22(2):248–254

    PubMed  CAS  Google Scholar 

  49. Ozgur HT, Walsh T Kent, Masaryk A, Seeger JF, Williams W, Krupinski E, Melgar M, Labadie E (2001) Correlation of cerebrovascular reserve as measured by acetazolamide-challenged SPECT with angiographic flow patterns and intra- or extracranial arterial stenosis. AJNR Am J Neuroradiol 22(5):928–936

    PubMed  CAS  Google Scholar 

  50. Furukawa M, Kashiwagi S, Matsunaga N, Suzuki M, Kishimoto K, Shirao S (2002) Evaluation of cerebral perfusion parameters measured by perfusion CT in chronic cerebral ischemia: comparison with xenon CT. J Comput Assist Tomogr 26(2):272–278

    Article  PubMed  Google Scholar 

  51. Kleiser B, Widder B (1992) Course of carotid artery occlusions with impaired cerebrovascular reactivity. Stroke 23(2):171–174

    PubMed  CAS  Google Scholar 

  52. Silvestrini M, Vernieri F, Pasqualetti P, Matteis M, Passarelli F, Troisi E, Caltagirone C (2000) Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic carotid artery stenosis. JAMA 283(16):2122–2127

    Article  PubMed  CAS  Google Scholar 

  53. Cigada M, Marzorati S, Tredici S, Iapichino G (2000) Cerebral CO2 vasoreactivity evaluation by transcranial Doppler ultrasound technique: a standardized methodology. Intensive Care Med 26(6):729–732

    Article  PubMed  CAS  Google Scholar 

  54. Mintun MA, Raichle ME, Martin WR, Herscovitch P (1984) Brain oxygen utilization measured with O-15 radiotracers and positron emission tomography. J Nucl Med 25(2):177–187

    PubMed  CAS  Google Scholar 

  55. Higashida RT, Meyers PM, Connors JJ, Sacks D, Strother CM, Barr JD, Wojak JC, Duckwiler GR (2005) Intracranial angioplasty & stenting for cerebral atherosclerosis: a position statement of the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, and the American Society of Neuroradiology. J Vasc Interv Radiol 16(10):1281–1285

    PubMed  Google Scholar 

  56. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360(9342):1267–1274

    Article  Google Scholar 

  57. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351(15):1493–1501

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Division of Interventional Neurovascular Radiology, University of California, San Francisco Medical Center, 505 Parnassus Avenue, L-352, San Francisco, CA, 94143-0628, USA

    Randall T. Higashida

  2. The Neurological Institute, New York Presbyterian Hospitals, College of Physicians & Surgeons, Columbia University, 710 West 168th Street, Room 404, New York, NY, 10032, USA

    Philip M. Meyers

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  1. Randall T. Higashida
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Correspondence to Randall T. Higashida.

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Higashida, R.T., Meyers, P.M. Intracranial angioplasty and stenting for cerebral atherosclerosis: new treatments for stroke are needed!. Neuroradiology 48, 367–372 (2006). https://doi.org/10.1007/s00234-006-0071-6

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  • DOI: https://doi.org/10.1007/s00234-006-0071-6

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