Skip to main content

Advertisement

SpringerLink
Log in

One-pass endovascular treatment of intracranial atherosclerotic stenosis with a novel PTA balloon and self-expanding microstent

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

We present a novel endovascular technique to treat intracranial atherosclerotic stenosis (ICS) with the specific potential to reduce the procedure-related complications which so far limited safety and efficacy of endovascular ICS intervention.

Methods

Six consecutive patients were included in this study with the following criteria of inclusion: (1) failure of dual antiplatelet therapy defined as recurrent TIA or ischemic stroke, (2) presence of ICS of ≥70 %, and (3) endovascular accessibility of the target lesion as judged by CTA or MRA. Technical feasibility, safety, and efficacy were observed for the first-ballon-then-stent (FBTS) technique using the percutaneous transluminal angioplasty (PTA) balloon microcatheter over which a self-expandable microstent can be directly delivered obviating the need to exchange microcatheters.

Results

FBTS was performed in six patients (four female, median age 69, median stenosis 82.5 %) all refractory to best medical treatment: three V4, two M1, and one supraclinoid ICA stenosis. PTA and stent deployment were technically feasible in all patients and immediately effective with a median postprocedural stenosis grade of 10 %. Angiographic and clinical safety measures were met with no occult or clinically evident hemorrhage or ischemic complications (four patients discharged without alteration in mRS, two patients with significant clinical improvement). No occurrence of TIA, stroke, or death was observed during follow-up.

Conclusion

The FBTS method in this series appeared to be safe and effective for the endovascular treatment of ICS. It bears the specific potential to reduce wire perforations, which so far have been linked to major procedure-related adverse events of endovascular ICS treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, Janis LS, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL Jr, Torbey MT, Zaidat OO, Rumboldt Z, Cloft HJ, SAMMPRIS Trial Investigators (2011) Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365:993–1003

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Zaidat OO, Fitzsimmons BF, Woodward BK, Wang Z, Killer-Oberpfalzer M, Wakhloo A, Gupta R, Kirshner H, Megerian JT, Lesko J, Pitzer P, Ramos J, Castonguay AC, Barnwell S, Smith WS, Gress DR, VISSIT Trial Investigators (2015) Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial. JAMA 313:1240–1248

    Article  CAS  PubMed  Google Scholar 

  3. Derdeyn CP, Fiorella D, Lynn MJ, Rumboldt Z, Cloft HJ, Gibson D, Turan TN, Lane BF, Janis LS, Chimowitz MI, Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial Investigators, (2013) Mechanisms of stroke after intracranial angioplasty and stenting in the SAMMPRIS Trial. Neurosurgery 72:777–795

    Article  PubMed  PubMed Central  Google Scholar 

  4. Derdeyn CP, Fiorella D, Lynn MJ, Barnwell SL, Zaidat OO, Meyers PM, Gobin YP, Dion J, Lane BF, Turan TN, Janis LS, Chimowitz MI, SAMMPRIS Trial Investigators (2013) Impact of operator and site experience on outcomes after angioplasty and stenting in the SAMMPRIS trial. J Neurointerv Surg 5:528–533

    Article  PubMed  Google Scholar 

  5. Spiotta AM, Miranpuri A, Chaudry MI, Turner RD, Turk AS (2013) Combined balloon stent technique with the Scepter C balloon and low-profile visualized intraluminal stent for the treatment of intracranial aneurysms. J Neuro Intervent Surg. doi:10.1136/neurintsurg-2012-010553

    Google Scholar 

  6. Möhlenbruch M, Herweh C, Behrens L, Jestaedt L, Amiri H, Ringleb PA, Bendszus M, Pham M (2014) The LVIS Jr. microstent to assist coil embolization of wide-neck intracranial aneurysms: clinical study to assess safety and efficacy. Neuroradiology 56:389–395

    Article  PubMed  Google Scholar 

  7. Turan TN, Cotsonis G, Lynn MJ, Wooley RH, Swanson S, Williams JE, Stern BJ, Derdeyn CP, Fiorella D, Chimowitz MI (2014) Intracranial stenosis: impact of randomized trials on treatment preferences of US neurologists and neurointerventionists. Cerebrovasc Dis 37:203–211

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Derdeyn CP, Chimowitz MI, Lynn MJ, Fiorella D, Turan TN, Janis LS, Montgomery J, Nizam A, Lane BF, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL Jr, Lynch JR, Zaidat OO, Rumboldt Z, Cloft HJ, Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial Investigators, (2014) Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet 383:333–341

    Article  PubMed  Google Scholar 

  9. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2015) Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation 131:e29–322

    Article  PubMed  Google Scholar 

  10. Fiorella D, Chow M, Anderson M, Woo H, Rasmussen PA, Masaryk TJ (2007) A 7-year experience with balloon-mounted coronary stents for the treatment of symptomatic vertebrobasilar atheromatous disease. Neurosurgery 61:236–243

    Article  PubMed  Google Scholar 

  11. Dumont TM, Kan P, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI (2012) Revisiting angioplasty without stenting for symptomatic intracranial atherosclerotic stenosis after the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS) study. Neurosurgery 71:1103–1110

    Article  PubMed  Google Scholar 

  12. Kabbasch C, Liebig T, Faymonville A, Dorn F, Mpotsaris A (2015) Initial clinical experience with a new self-expanding nitinol microstent for the treatment of wide-neck intracranial cerebral aneurysms: the Acandis Acclino Stent. J Vasc Interv Neurol 8:1–6

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Wang Y, Chen JM, Liu X, Wang J, Li LH, Deng JP, Duan YY (2013) Evaluation of the combined application of ultrasound imaging techniques for middle cerebral artery stent surveillance and follow-up study. PLoS One. doi:10.1371/journal.pone.0079410

    Google Scholar 

  14. Vajda Z, Schmid E, Güthe T, Klötzsch C, Lindner A, Niehaus L, Sperber W, Peters J, Arnold G, Bäzner H, Henkes H (2012) The modified Bose method for the endovascular treatment of intracranial atherosclerotic arterial stenoses using the Enterprise stent. Neurosurgery 70:91–101

    Article  PubMed  Google Scholar 

  15. Lee KY, Chen DY, Hsu HL, Chen CJ, Tseng YC (2016) Undersized angioplasty and stenting of symptomatic intracranial tight stenosis with Enterprise: evaluation of clinical and vascular outcome. Interv Neuroradiol 22:187–195

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany

    Markus A Möhlenbruch, Johannes Pfaff, Christian Herweh, Martin Bendszus & Mirko Pham

  2. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany

    Julian Bösel, Timolaos Rizos, Simon Nagel & Peter A Ringleb

Authors
  1. Markus A Möhlenbruch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johannes Pfaff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Herweh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Julian Bösel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Timolaos Rizos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Simon Nagel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter A Ringleb
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Martin Bendszus
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mirko Pham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Markus A Möhlenbruch.

Ethics declarations

We declare that all human and animal studies have been approved by the institutional review board of the Heidelberg Medical University Faculty and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

MAM has received consulting honoraria, speaker honoraria and travel support outside this work from Acandis, Codman, Covidien, MicroVention, Phenox and Stryker. JP has received travel expenses from Siemens and Stryker. CH has received travel expenses from Covidien. JB has received honoraria and travel support from Zoll, CR Bard, Seiratherm, Sedana Medical, Covidien and Boehringer. TR has received consulting honoraria, speaker honoraria and travel support from BMS Pfizer, Boehringer Ingelheim, Bayer HealthCare and Daiichi Sankyo. SN received consulting honoraria, speaker honoraria and travel support from Boehringer-Ingelheim, Bayer, Pfizer and Brainomix Ltd. PAR has received speaker honoraria and travel support from Boehringer Ingelheim, Daiichi Sanyo, Pfizer and Bayer and compensation for advisory board meetings from Covidien and Boehringer Ingelheim. MB has received consulting honoraria and speaker honoraria from Codman, Guerbet, Novartis, Roche and Vascular Dynamics. MP has received speaker honoraria and travel reimbursement from Penumbra and Covidien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Möhlenbruch, M.A., Pfaff, J., Herweh, C. et al. One-pass endovascular treatment of intracranial atherosclerotic stenosis with a novel PTA balloon and self-expanding microstent. Neuroradiology 58, 893–899 (2016). https://doi.org/10.1007/s00234-016-1716-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-016-1716-8

Keywords

Search

Navigation