Skip to main content

Endovascular therapy for acute thrombotic occlusion of the intracranial artery

Neuroradiology volume 46, pages 453–458 (2004)Cite this article

Abstract

The goal of this study was to evaluate the efficacy of endovascular therapy for acute thrombotic occlusion. Six patients with acute thrombotic occlusion in the middle cerebral or basilar arteries underwent treatment with intra-arterial thrombolysis, followed by assessment of residual stenosis. If residual stenosis was greater than 70%, percutaneous transluminal angioplasty (PTA) was performed in the same session; otherwise, patients were anticoagulated, and PTA was performed several days later. Successful recanalization was achieved in five of six patients. One patient died of massive infarction, because of the failure of recanalization of the M1 segment. At discharge, modified Rankin scale distribution of the patients was: grade 0, one patient; grade 1, one patient; grade 2, two patients; grade 3, one patient; grade 6, one patient. Retreatment was required via PTA or stenting in two patients in which type C stenosis was present. In conclusion, endovascular therapy for acute thrombotic occlusion of an intracranial artery appears to be effective compared to conservative therapy. However, further refinement of the technique is required to prevent various complications, including vessel perforation, dissection, perforating artery occlusion and restenosis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Al-Mubarak N, Gomez CR, Vitek JJ, et al (1998) Stenting of symptomatic stenosis of the intracranial internal carotid artery. AJNR Am J Neuroradiol 19:1949–1951

    CAS  PubMed  Google Scholar 

  2. Gomez CR, Misra VK, Liu MW, et al (2000) Elective stenting of symptomatic basilar artery stenosis. Stroke 31:95–99

    CAS  PubMed  Google Scholar 

  3. Yokote H, Terada T, Ryujin K et al (1998) Percutaneous transluminal angioplasty for arteriosclerotic lesions. Neuroradiology 40:590–596

    Article  CAS  PubMed  Google Scholar 

  4. Komiyama M, Tamura K, Nagata Y, et al (1992) Percutaneous transluminal angioplasty for the acute thrombotic occlusion of the middle cerebral artery. Surg Cereb Stroke 20:45–49

    Google Scholar 

  5. Phatouros CC, Higashida RT, Malek AM, et al (1999) Endovascular stenting of an acutely thrombosed basilar artery: technical case report and review of the literature. Neurosurgery 44:667–673

    CAS  PubMed  Google Scholar 

  6. Terada T, Yokote H, Tsuura M et al (1994) Tissue plasminogen activator thrombolysis and transluminal angioplasty in the treatment of basilar artery thrombosis: case report. Surg Neurol 41:358–361

    Article  CAS  PubMed  Google Scholar 

  7. Ueda T, Hatakeyama T, Kohno K et al (1997) Endovascular treatment for acute thrombotic occlusion of the middle cerebral artery: local intra-arterial thrombolysis combined with percutaneus transluminal angioplasty. Neuroradiology 39:99–104

    Article  CAS  PubMed  Google Scholar 

  8. North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl Med 325:445–453

    Google Scholar 

  9. van Swieten JC, Koudstaal PJ, Visser MC et al (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607

    PubMed  Google Scholar 

  10. Mori T, Fukuoka M, Kazita K et al (1998) Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty. AJNR Am J Neuroradiol 19:1525–1533

    CAS  PubMed  Google Scholar 

  11. Furlan A, Higashida R, Wechsler L et al (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT-II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA 282:2003–2011

    CAS  Google Scholar 

  12. Hacke W, Zeumer H, Ferbert A et al (1988) Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19:1216–1222

    CAS  PubMed  Google Scholar 

  13. Masuo O, Terada T, Walker G et al (2002) Study of the patency of small arterial branches after stent placement with an experimental in vivo model. AJNR 23:706–710

    Google Scholar 

  14. Levy EI, Boulos AS, Hanel RA, et al (2003) In vivo model of intracranial stent implantation: a pilot study to examine the histological response of cerebral vessels after randomized implantation of heparin-coated and uncoated endoluminal stents in a blind fashion. J Neurosurg 98:544–553

    PubMed  Google Scholar 

  15. Gruentzig AR, King SB III, Schlumpf M, et al (1987) Long-term follow-up after percutaneous transluminal coronary angioplasty: the early Zurich experience. N Engl J Med 316:1127–1132

    CAS  PubMed  Google Scholar 

  16. Nobuyoshi M, Kimura T, Nosaka H, et al (1998) Restenosis after successful percutaneous transluminal coronary angioplasty: serial angiographic follow-up of 229 patients. J Am Coll Cardiol 12:616–623

    Google Scholar 

  17. Herdeg C, Oberhoff M, Baumbach A, et al (2000) Local paclitaxel delivery for the prevention of restenosis: biological effects and efficacy in vivo. J Am Coll Cardiol 35:1969–1976

    Article  CAS  PubMed  Google Scholar 

  18. Morice MC, Serruys PW, Sousa JE, et al (2002) Randomized study with the sirolimus-coated by velocity balloon-expandable stent in the treatment of patients with de novo native coronary artery lesions: a randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 346:1770–1771

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan

    Tomoyuki Tsumoto, Tomoaki Terada, Mitsuharu Tsuura, Yukiaki Ryujin, Hiroyuki Matsumoto, Osamu Masuo, Hiroo Yamaga & Toru Itakura

  2. 811-1 Kimiidera Wakayama City, 641-0012, Wakayama, Japan

    Tomoyuki Tsumoto

Authors
  1. Tomoyuki Tsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomoaki Terada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mitsuharu Tsuura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yukiaki Ryujin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroyuki Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Osamu Masuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroo Yamaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Toru Itakura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomoyuki Tsumoto.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tsumoto, T., Terada, T., Tsuura, M. et al. Endovascular therapy for acute thrombotic occlusion of the intracranial artery. Neuroradiology 46, 453–458 (2004). https://doi.org/10.1007/s00234-004-1219-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-004-1219-x

Keywords

  • Acute thrombotic occlusion
  • Endovascular therapy
  • Percutaneous transluminal angioplasty (PTA)