, Volume 52, Issue 7, pp 645–651

Treatment of intracranial atherosclerotic arterial stenoses with a balloon-expandable cobalt chromium stent (Coroflex Blue): procedural safety, efficacy, and midterm patency

  • Zsolt Vajda
  • Elina Miloslavski
  • Thomas Güthe
  • Elisabeth Schmid
  • Christoph Schul
  • Guido Albes
  • Hans Henkes
Interventional Neuroradiology



We evaluated the coronary balloon-expandable cobalt chromium stent Coroflex Blue for the treatment of intracranial atherosclerotic arterial stenoses (IAAS).


Between March 2007 and October 2007, a total of 25 patients (20 male, age median 67 years) with 30 IAAS underwent endovascular treatment using Coroflex Blue stents (B. Braun, Germany). Location and degree of target stenoses before and after treatment and at follow-up and adverse clinical sequelae of treatment were registered. Angiographic follow-up was scheduled for 6, 12, 26, and 52 weeks after the treatment.


The 30 treated lesions were located as follows: nine in intracranial–extradural internal carotid artery (ICA), three in intradural ICA, five in middle cerebral artery, eight in intradural vertebral artery, and five in basilar artery. The technical success rate was 100%. The degree of stenoses prior to and after treatment was 61 ± 2% and 26 ± 3% (mean ± SE), respectively. A residual stenosis of <50% was achieved in 29 (97%) procedures. Treatment was uneventful in 28 out of 30 procedures (93%); one patient suffered a transient and one patient a permanent neurological deficit. Angiographic follow-up was available in all of the patients (100%) after 15.2 months (median) and showed significant (i.e., more than 50%) degree of recurrent stenosis in 11 (37%) of the lesions. Retreatment was performed in 11 (37%) lesions.


The Coroflex Blue stent is easily inserted and safely deployed into intracranial arteries. The incidence of recurrent stenoses remains a concern. Stringent angiographic and clinical follow-up and retreatment are therefore mandatory.


Atherosclerosis Intracranial stenosis Stent Endovascular Cobalt chromium 


  1. 1.
    Bogousslavsky J, Van Melle G, Regli F (1988) The Lausanne stroke registry: analysis of 1,000 consecutive patients with first stroke. Stroke 19:1083–1092PubMedGoogle Scholar
  2. 2.
    Mazighi M, Labreuche J, Gongora-Rivera F, Duyckaerts C, Hauw JJ, Amarenco P (2008) Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke. Stroke 39:1142–1147CrossRefPubMedGoogle Scholar
  3. 3.
    Kern R, Steinke W, Daffertshofer M, Prager R, Hennerici M (2005) Stroke recurrences in patients with symptomatic vs asymptomatic middle cerebral artery disease. Neurology 65:859–864CrossRefPubMedGoogle Scholar
  4. 4.
    Chimowitz MI, Lynn MJ, Howlett-Smith H et al (2005) Warfarin-aspirin symptomatic intracranial disease trial investigators (2005) comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352:1305–1316CrossRefPubMedGoogle Scholar
  5. 5.
    Kasner SE, Chimowitz MI, Lynn MJ et al (2006) Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 113:555–563CrossRefPubMedGoogle Scholar
  6. 6.
    Fiorella D, Chow MM, Anderson M, Woo H, Rasmussen PA, Masaryk TJ (2007) A 7-year experience with balloon-mounted coronary stents for the treatment of symptomatic vertebrobasilar intracranial atheromatous disease. Neurosurgery 61:236–242CrossRefPubMedGoogle Scholar
  7. 7.
    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 47:222–228CrossRefPubMedGoogle Scholar
  8. 8.
    Albuquerque FC, Levy EI, Turk AS et al (2008) Angiographic patterns of Wingspan in-stent restenosis. Neurosurgery 63:23–27CrossRefPubMedGoogle Scholar
  9. 9.
    Kurre W, Berkefeld J, Sitzer M, Neumann-Haefelin T, Du Mesnil De Rochemont R (2008) Treatment of symptomatic high-grade intracranial stenoses with the balloon-expandable Pharos stent: initial experience. Neuroradiology 50:701–708CrossRefPubMedGoogle Scholar
  10. 10.
    Schumacher HC, Meyers PM, Higashida RT, Derdeyn CP, Lavine SD, Nesbit GM, Sacks D, Rasmussen P, Wechsler LR (2009) Reporting standards for angioplasty and stent-assisted angioplasty for intracranial atherosclerosis. Stroke 40:e348–e365CrossRefPubMedGoogle Scholar
  11. 11.
    Suh DC, Kim JK, Choi JW et al (2008) Intracranial stenting of severe symptomatic intracranial stenosis: results of 100 consecutive patients. AJNR Am J Neuroradiol 29:781–785CrossRefPubMedGoogle Scholar
  12. 12.
    Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI (2000) A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 21:643–646PubMedGoogle Scholar
  13. 13.
    Berg-Dammer E, Henkes H, Weber W, Berlit P, Kühne D (1998) Percutaneous transluminal angioplasty of intracranial artery stenosis: clinical results in 24 patients. Neurosurg Focus 15:e13Google Scholar
  14. 14.
    Mazighi M, Yadav JS, Abou-Chebl A (2008) Durability of endovascular therapy for symptomatic intracranial atherosclerosis. Stroke 39:1766–1769CrossRefPubMedGoogle Scholar
  15. 15.
    SSYLVIA Study Investigators (2004) Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA). Stroke 35:1388–1392CrossRefGoogle Scholar
  16. 16.
    Jiang WJ, Xu XT, Jin M, Du B, Dong KH, Dai JP (2007) Apollo stent for symptomatic atherosclerotic intracranial stenosis: study results. AJNR Am J Neuroradiol 28:830–834PubMedGoogle Scholar
  17. 17.
    Jiang WJ, Wang YJ, Du B, Wang SX, Wang GH, Jin M, Dai JP (2004) Stenting of symptomatic M1 stenosis of middle cerebral artery: an initial experience of 40 patients. Stroke 35:1375–1380CrossRefPubMedGoogle Scholar
  18. 18.
    Puetz V, Gahn G, Becker U, Mucha D, Mueller A, Weir NU, Wiedemann B, von Kummer R (2008) Endovascular therapy of symptomatic intracranial stenosis in patients with impaired regional cerebral blood flow or failure of medical therapy. AJNR Am J Neuroradiol 29:273–280CrossRefPubMedGoogle Scholar
  19. 19.
    Wittkugel O, Rosenkranz M, Burckhardt D, Niessen WD, Espersen T, Zeumer H, Fiehler J, Grzyska U (2009) Long-term outcome after endovascular treatment of high-risk patients with recurrently symptomatic intracranial stenoses of the posterior circulation. Fortschr Röntgenstr. doi:10.1055/s-0028-1109343 Google Scholar
  20. 20.
    Bose A, Hartmann M, Henkes H et al (2007) A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 38:1531–1537CrossRefPubMedGoogle Scholar
  21. 21.
    Steinfort B, Ng PP, Faulder K, Harrington T, Grinnell V, Sorby W, Morgan MK (2007) Midterm outcomes of paclitaxel-eluting stents for the treatment of intracranial posterior circulation stenoses. J Neurosurg 106:222–225CrossRefPubMedGoogle Scholar
  22. 22.
    Dogan A, Fields J, Petersen B, Lee D, Nesbit G, Clark W, Lutsep H, Bhardwaj A, Barnwell S (2009) Drug eluting stents for symptomatic intracranial and vertebral artery stenosis: a single center experience with high rates of clinical and angiographic follow-up. Intervent Neuroradiol 15(Suppl 1):98Google Scholar
  23. 23.
    Hähnel S, Ringleb P, Hartmann M (2006) Treatment of intracranial stenoses using the Neuroform stent system: initial experience in five cases. Neuroradiology 48:479–485CrossRefPubMedGoogle Scholar
  24. 24.
    Turk AS, Ahmed A, Niemann DB, Aagaard-Kienitz B, Brooks N, Levine RL (2007) Utilization of self-expanding stents in the treatment of intracranial atherosclerotic disease in the distal small cerebral vessels. Neuroradiology 49:659–663CrossRefPubMedGoogle Scholar
  25. 25.
    Turk AS, Levy EI, Albuquerque FC et al (2008) Influence of patient age and stenosis location on wingspan in-stent restenoses. AJNR Am J Neuroradiol 29:23–27CrossRefPubMedGoogle Scholar
  26. 26.
    Berkefeld J, Zanella FE (2009) Intracranial stenting of atherosclerotic stenoses: current status and perspectives. Klin Neuroradiol 19:38–44CrossRefPubMedGoogle Scholar
  27. 27.
    Unverdorben M, Vallbracht C, Cremers B et al (2009) Paclitaxel-coated balloon catheter versus paclitaxel-coated stent for the treatment of coronary in-stent restenosis. Circulation 119:2986–2994CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Zsolt Vajda
    • 1
  • Elina Miloslavski
    • 1
  • Thomas Güthe
    • 1
    • 2
  • Elisabeth Schmid
    • 3
  • Christoph Schul
    • 4
  • Guido Albes
    • 1
  • Hans Henkes
    • 1
    • 5
  1. 1.Klinik für NeuroradiologieKatharinenhospital—Klinikum StuttgartStuttgartGermany
  2. 2.Klinik für NeurologieKatharinenhospital KlinikumStuttgartGermany
  3. 3.Klinik für NeurologieBürgerhospital KlinikumStuttgartGermany
  4. 4.Klinik für NeurochirurgieKatharinenhospital KlinikumStuttgartGermany
  5. 5.Medizinische Fakultät der UniversitätDuisburg-EssenGermany

Personalised recommendations