Advertisement

Intracranial Angioplasty and Stenting

  • Pearse Morris
Chapter

Abstract

The application of endovascular technology to the treatment of severe intracranial atherosclerotic occlusive disease derives from the recognition of the grave prognosis for such patients once they become symptomatic and from the lack of an established mode of effective treatment. It is thought, based on various sources, that intracranial atherosclerotic stenotic lesions carry a risk of stroke of 7% to 56% per year and a strong correlation with high risk of death from ischemic heart disease, but the studies supporting these assumptions are mostly small and retrospective or nonrandomized in methodology.1–5 The efficacy of medical treatment of such lesions with antiplatelet therapy and/or warfarin is not yet firmly established, and external carotid artery to internal carotid artery surgical bypass does not seem to be effective for most patients.6 A small, retrospective study of warfarin versus aspirin in the treatment of intracranial stenosis indicates a slightly greater efficacy from warfarin in symptomatic patients. Rates of major vascular events of 8.4% (stroke 3.6%) with warfarin and 18.1% (stroke 10.4%) per year with aspirin were seen.? Evidence supporting a slightly greater efficacy for warfarin compared with antiplatelet medication was also seen in an observational study of symptomatic intracranial atherosclerotic disease, in which a 31% and 55.8% risk of ischemic events was seen in patients taking warfarin or antiplatelet agents, respectively.5 Follow-up studies indicate that intra-cranial atherosclerotic disease once detected is also likely to have a progressive course.58 In summary, the prospective management of a patient with severe intracranial atherosclerotic disease, particularly once it becomes symptomatic, is still a dilemma.

Keywords

Internal Carotid Artery Vertebral Artery Basilar Artery Posterior Inferior Cerebellar Artery Left Vertebral Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Craig DR, Meguro K, Watridge C, Robertson JT, Barnett HJM, Fox AJ (1982) Intracranial internal carotid artery stenosis. Neurology 13: 825–828.Google Scholar
  2. 2.
    Marzewski DJ, Furlan AJ, St Louis P, Little JR, Modic MT (1982) Intracranial internal carotid artery stenosis: longterm preognosis. Stroke 13: 821–824.PubMedCrossRefGoogle Scholar
  3. 3.
    Wechsler LR, Kistler JP, Davis KR, Kaminski MJ (1986) The prognosis of carotid siphon stenosis. Stroke 17: 714–718.PubMedCrossRefGoogle Scholar
  4. 4.
    Bogousslavsky J, Barnett HJM, Fox AJ, Hachinski VC, Taylor W (1986) Atherosclerotic disease of the middle cerebral artery. Stroke 17: 1112–1120.PubMedCrossRefGoogle Scholar
  5. 5.
    Thiis VN, Albers GW (2000) Symptomatic intracranial atherosclerosis. Outcome of patients who fail antithrombotic therapy. Stroke 55: 490–497.Google Scholar
  6. 6.
    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: 1191–1200.CrossRefGoogle Scholar
  7. 7.
    Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Silliman S, Pessin MS, Weichel E, Sila CA, Furlan AJ, Kargman DE, Sacco RL, Wityk RJ, Ford G, Fayad PB (1995) The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology 45: 1488–1493.PubMedCrossRefGoogle Scholar
  8. 8.
    Akins PT, Pilgram TK, Cross DT, Moran CJ (1998) Natural history of stenosis from intracranial atherosclerosis by serial angiography. Stroke 29: 433–438.PubMedCrossRefGoogle Scholar
  9. 9.
    Higashida RT, Tsai FY, Halbach VV, Dowd CF, Hieshima GB (1993) Cerebral percutaneous transluminal angioplasty. Heart Dis Stroke 2: 497–502.PubMedGoogle Scholar
  10. 10.
    Volk EE, Prayson RA, Perl J (1997) Autopsy finding of fatal complications of posterior cerebral circulation angioplasty. Arch Pathol Lab Med 121: 738–740.PubMedGoogle Scholar
  11. 11.
    Connors JJ, Wojak JC (1999) Percutaneous transluminal angioplasty for intracranial atherosclerotic lesions: evolution of technique and short-term results. J Neurosurg 91: 415–423.PubMedCrossRefGoogle Scholar
  12. 12.
    Marks MP, Marcellus M, Norbash AM, Steinberg GK, Tong D, Albers GW (1999) Outcome of angioplasty for atherosclerotic intracranial stenosis. Stroke 30: 1065–1069.PubMedCrossRefGoogle Scholar
  13. 13.
    Callahan AS, Berger BL (1997) Balloon angioplasty of intracranial arteries for stroke prevention. JNeuroimag7:232235.Google Scholar
  14. 14.
    Takis C, Kwan ES, Pessin MS, Jacobs DH, Caplan LR (1997) Intracranial angioplasty: experience and complications. AJNR 18: 1661–1668.PubMedGoogle Scholar
  15. 15.
    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 Psych 60: 377–381.CrossRefGoogle Scholar
  16. 16.
    Lee RM (1995) Morphology of cerebral arteries. Pharmacol Ther 66: 149–173.PubMedCrossRefGoogle Scholar
  17. 17.
    Scott GE, Neubuerger KT, Denst J (1960) Dissecting aneurysms of intracranial arteries. Neurology 10: 22–27.PubMedCrossRefGoogle Scholar
  18. 18.
    Nahser HC, Henkes H, Weber W, Berg-Dammer E, Yousry TA, Kohne D (2000) Intracranial vertebrobasilar stenosis: angioplasty and follow-up. AJNR 21: 1293–1301.PubMedGoogle Scholar
  19. 19.
    Touho H, Takaoka M, Ohnishi H, Furuoka N, Karasawa J (1995) Percutaneous transluminal angioplasty for severe stenosis of the posterior cerebral artery: case report. Surg Neurol 43: 42–47.PubMedCrossRefGoogle Scholar
  20. 20.
    Touho H, Ohnishi H, Karasawa J, Furuoka N, Komatsu T (1994) Percutaneous transluminal angioplasty for acute stroke due to stenosis of major cerebral vessels: report of two cases. Surg Neurol 41: 362–367.PubMedCrossRefGoogle Scholar
  21. 21.
    Mori T, Fukuoka M, Kazita K, Mori K (1998) Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty. AJNR 19: 1525–1533.PubMedGoogle Scholar
  22. 22.
    Mori T, Mori K, Fukuoka M, Arisawa M, Honda S (1997) Percutaneous transluminal cerebral angioplasty: serial angiographic follow-up after successful dilatation. Neuroradiology 39: 111–116.PubMedCrossRefGoogle Scholar
  23. 23.
    Ryan TJ, Bauman WB, Kennedy JW, Keriakes DJ, King SB, Mccallister BD, Smith SC, Ullyot DJ (1993) Guidelines for Percutaneous Transluminal Coronary Angioplasty. A Report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures. J Am Coll Cardiol 22: 2033–2054.CrossRefGoogle Scholar
  24. 24.
    Ohman EM, Marquis JF, Ricci DR, Brown RIG, Knudtson ML, Kereiakes DJ, Samaha JK, Margolis JR, Niederman AL, Dean LS, Gurbel PA, Sketch MH, Wildermann NM, Lee KL, Califf RM (1994) A randomized comparison of the effects of gradual prolonged versus standard primary balloon inflation on early and late outcome. Results of a multicenter clinical trial. Circulation 89: 1118–1125.PubMedCrossRefGoogle Scholar
  25. 25.
    Gomez CR (1998) The role of carotid angioplasty and stenting. Sem Neurol 18: 501–511.CrossRefGoogle Scholar
  26. 26.
    Dorros G, Cohn JM, Palmer LE (1998) Stent deployment resolves a petrous carotid artery angioplasty dissection. AJNR 19: 392–394.PubMedGoogle Scholar
  27. 27.
    Mori T, Kazita K, Choxru K, Mima T, Motu K (2000) Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease. AJNR 21: 249–254.PubMedGoogle Scholar
  28. 28.
    Feldman RL, Trigg L, Gaudier J, Galat J (1996) Use of Coronary Palmaz-Schatz stent in the percutaneous treatment of an intracranial carotid artery stenosis. Cath Cardiovasc Diag 38: 316–319.CrossRefGoogle Scholar
  29. 29.
    Morris PP, Martin EM, Regan J, Braden G (1999) Intracranial deployment of coronary stents for symptomatic atherosclerotic disease. AJNR 20: 1688–1694.PubMedGoogle Scholar
  30. 30.
    Al-Mubarak N, Gomez CR, Vitek JJ, Roubin GS (1998) Stenting of symptomatic stenosis of the intracranial internal carotid artery. AJNR 19: 1949–1951.PubMedGoogle Scholar
  31. 31.
    Phatouros CC, Higashida RT, Malek AM, Smith WS, Mully TW, Dearmond SJ, Dowd CF, Halbach V V (1999) Endovascular stenting of an acutely thrombosed basilar artery: technical case report and review of the literature. Neurosurgery 44:667–673.Google Scholar
  32. 32.
    Lanzino G, Fessler RD, Miletich RS, Guterman LR, Hopkins LN (1999) Angioplasty and stenting of basilar artery stenosis: technical case report. Neurosurgery 45: 404–407.PubMedCrossRefGoogle Scholar
  33. 33.
    Lanzino G, Wakhloo AK, Fessler RD, Hartney ML, Guter-Man LR, Hopkins LN (1999) Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91: 538–546.PubMedCrossRefGoogle Scholar
  34. 34.
    Lanzino G, Guterman LR, Hopkins LN (1999) The case for stenting. Clin Neurosurg 45: 249–255.PubMedGoogle Scholar
  35. 35.
    Gomez CR, Misra VK, Liu MW, Wadlington VR, Terry JB, Tulyapronchote R, Campbell MS (2000) Elective stenting of symptomatic basilar artery stenosis. Stroke 31: 95–99.PubMedCrossRefGoogle Scholar
  36. 36.
    Mori T, Kazita K, Seike M, Norma Y, Mori K (1999) Successful cerebral artery stent placement for total occlusion of the vertebrobasilar artery in a patient suffering from acute stroke. Case report. J Neurosurg 90: 955–958.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Pearse Morris
    • 1
  1. 1.School of MedicineWake Forest UniversityWinston-SalemUSA

Personalised recommendations