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Neurocritical Care

, Volume 2, Issue 2, pp 189–197 | Cite as

Submaximal angioplasty and staged stenting for severe posterior circulation intracranial stenosis

A technique in evolution
  • Elad I. Levy
  • Jay U. Howington
  • Johnathan A. Engh
  • Ricardo A. Hanel
  • Naveh Levy
  • Stanley H. Kim
  • Kevin J. Gibbons
  • Lee R. Guterman
  • Nelson Hopkins
Opinions And Arguments

Abstract

Introduction: Severe medically refractory intracranial stenosis portends a grave prognosis. Recent advances in stent technology have enabled clinicians to treat these lesions. Evidence in the coronary literature suggests that stenting without predilation angioplasty is as safe and effective as stenting immediately preceded by predilation angioplasty for the treatment of severely stenotic lesions. Because of marked differences in vessel histology and differences in the sensitivity of the cerebral and coronary vascular beds to embolic insult, direct stenting of severe intracranial stenoses may be more prone to neurological complications than a conventional or staged stenting procedure.

Methods: We reviewed our clinical experience with conventional, direct, and staged stenting for high-grade stenoses involving the posterior intracranial circulation. We also reviewed the literature and experimental data supporting the rationale for staged stenting.

Results: In our experience, no permanent neurological morbidity was identified in four patients treated with a staged approach. In contrast, one of three patients with conventional stenting of the basilar artery and two of four patients treated with direct basilar stenting had permanent neurological sequelae.

Conclusion: For patients with high-grade posterior circulation intracranial stenoses involving the perforator-rich zones of the basilar artery, staged stenting may reduce procedure-related morbidity. A staged approach allows for plaque stabilization resulting from postangioplasty fibrosis, which may protect patients from “snowplowing,” embolic shower of debris, or dissection. Further clinical, in vivo, and histological investigation is warranted.

Key Words

Angioplasty basilar artery intracranial atherosclerosis intracranial stenosis intracranial stenting neurovascular stenting 

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Copyright information

© Humana Press Inc. 2005

Authors and Affiliations

  • Elad I. Levy
    • 1
  • Jay U. Howington
    • 1
  • Johnathan A. Engh
    • 3
  • Ricardo A. Hanel
    • 1
  • Naveh Levy
    • 2
  • Stanley H. Kim
    • 1
  • Kevin J. Gibbons
    • 1
  • Lee R. Guterman
    • 1
  • Nelson Hopkins
    • 1
  1. 1.Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical SciencesUniversity at Buffalo, State University of New YorkBuffalo
  2. 2.Department of RadiologyUniversity at Buffalo, State University of New YorkBuffalo
  3. 3.Department of NeurosurgeryThe University of Pittsburgh Medical CenterPittsburgh

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