Intracranial angioplasty and stent implantation in atherosclerotic lesions

Authors: F. Charvát 1;  J. Mašková 1;  J. Lacman 1;  V. Beneš 2
Authors‘ workplace: Radiologické oddělení, ÚVN Praha 1;  Neurochirurgická klinika, 1. LF UK a VFN, Praha 2
Published in: Cesk Slov Neurol N 2008; 71/104(2): 190-196
Category: Short Communication


Authors report periprocedural and short term results of intracranial stenoses treatment using angioplasty and stent implantation.

In the period from 8/2002 to 4/2007 (56 months) altogether 53 patients were treated in our department. Group consists of 12 women and 41 men (mean age 63 years), 48 lesions were symptomatic, 5 were asymptomatic. 56 procedures were performed with 53 stents implantations. 46 stenoses (84 %, n = 55) were located in anterior circulation. 9 stenoses were in posterior circulation (16 %). All procedures were done from femoral approach. Patients were put on clopidogrel (Plavix, Sanofi Pharma, Bristol-Meyer) and acetylsalicylic acid (Anopyrin, Zentiva, CZ) 3 days before the procedure. Bolus of heparin (Heparin Natrium, Zentiva, CZ) was given in the beginning of procedure. Combination of Plavix and Anopyrin was used for 1 month after the procedure and Anopyrin long-life. Balloon – expandable stents were used in 41 lesions (77 %, n = 53), self-expandable stents were used in 12 lesions (23 %, n = 53).

Primary technical success was achieved in 48 patients (91 %, n = 53), secondary technical success rate was 96 %. There were 9 periprocedural complications (16 %, n = 56), two minor, without sequelae, seven major leading to change of treatment and prolonged hospital stay. One procedure related dead occurred.

Angioplasty with stent implantation was indicated in symptomatic patients with stenosis greater than 50 %. Our periprocedure results show, that stent implantation is technically feasible in most cases. The periprocedure results and complications rate in our group are comparable with those of other published studies.

Key words:
stroke – cerebral arteries – stent – intracranial atherosclerosis


1. de Rochemont Rdu M, Turowski B, Buchkremer M, Sitzer M, Zanella FE, Berkefeld J. Reccurent symptomatic high – grade intracranial stenoses: safety and efficacy of undersized stents- initial experience. Radiology 2004; 231: 45–49.

2. Benesch CG, Chimowitz MI. Best treatment for intracranial arterial stenosis? 50 years of uncertainty. The WASID investigators. Neurology 2000; 55: 465–466.

3. Marks MP, Marcellus M, Norbash AM, Steinberg GK, Tong D, Albers GW. Outcome of angioplasty for atherosclerotic intracranial stenosis. Stroke 1999; 30: 1065–1069.

4. The EC/IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 1985; 313: 1191–1200.

5. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005; 352:1305–1316.

6. Takis C, Kwan ES, Pessin MS, Jacobs DH, Caplan LR. Intracranial angioplasty: experience and complications. AJNR Am J Neuroradiol 1997; 18: 1661–1668.

7. Marks MP, Wojak JC, Al-Ali F, Jayaraman M, Marcellus ML, Connors JJ et al. Angioplasty for symptomatic intracranial stenosis: clinical outcome. Stroke 2006; 37: 1016–1020.

8. Wojak JC, Dunlap DC, Hargrave KR, DeAlvare LA, Culbertson HS, Connors JJ. 3rd. Intracranial angioplasty and stenting: long-term results from a single centre. AJNR Am J Neuroradiol 2006; 27: 1882–1892.

9. Morris PP, Martin EM, Regan J, Braden G. Intracranial deployment of coronary stents for symptomatic atherosclerotic disease. AJNR Am J Neuroradiol 1999; 20: 1688–1694.

10. Lylyk P, Cohen JE, Cerrato R, Ferrario A, Miranda C. Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections. AJNR Am J Neuroradiol 2002; 23: 430–436.

11. The SSYLVIA study investigators. Stenting of symptomatic atherosclerotic lesions in the vertebral in intracranial arteries (SSYLVIA): study results. Stroke 2004; 35: 1388–1392.

12. Jiang WJ, Wang YJ, Du B, Wang SX, Wang GH, Jin M et al. Stenting of symptomatic M1 stenosis of modele cerebral artery: an initial experience of 40 patients. Stroke 2004; 35: 1375–1380.

13. Gupta R, Al-Ali F, Thomas AJ, Horowitz MB, Barrow T, Vora NA et al. Safety, feasibility and short term follow up of drug- eluting stent placement in the intracranial an extracranial circulation. Stroke 2006; 37: 2564–2566.

14. Nahser HS, Henkes H, Weber W, Berg-Dammer E, Yousry TA, Kühne D. Intracranial vertebrobasilar stenosis: angioplasty and follow-up. AJNR Am J Neuroradiol 2000; 21: 1293–1301.

15. Phatouros CC, Lefler JE, Higashida RT, Meyers PM, Malek AM, Dowd CF et al. Primary stenting for high-grade basilar artery stenosis. AJNR Am J Neuroradiol 2000; 21: 1744–1749.

16. Lee TH, Kim DH, Lee BH, Kim HJ, Choi CH, Park KP et al. Preliminary results of endovascular stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. AJNR Am J Neuroradiol 2005; 26: 166–174.

17. Alazzaz A, Thornton J, Aletich V, Debrun GM, Ausman JI, Charbel F. Intracranial percutaneous transluminal angioplasty for arteriosclerotic stenosis. Arch Neurol 2000; 57: 1625–1630.

18. Mori T, Fukuoka M, Kazita K, Mori K. Follow-up after intracranial percutaneous transluminal cerebral balloon angioplasty. AJNR Am J Neuroradiol 1998; 19: 1525–1533.

19. Mori T, Kazita K, Chokyu K, Mima T, Mori K. Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease. AJNR Am J Neuroradiol 2000; 21: 249–254.

20. Rajan DK, Patel NH, Valji K, Cardella JF, Bakal C, Brown D et al. Quality improvement guidelines for percutaneous management of acute limb ischemia. J Vasc Interv Radiol 2005; 16: 585–595.

21. Schumacher HC, Khaw AV, Meyers PM, Gupta R, Higashida RT. Intracranial angioplasty and stent placement for cerebral atherosclerosis. J Vasc Interv Radiol 2004; 15: S123–S132.

22. Akins PT, Pilgram TK, Gross DT, Moran CJ. Natural history of stenosis from intracranial atherosclerosis by serial angiography. Stroke 1998; 29: 433–438.

23. Marini C, Totaro R, Carolei A. Long-term prognosis of cerebral ischemia in young adults. National Research Council Study Group on Stroke in the Young. Stroke 1999; 30: 2320–2325.

24. Ecker RD, Levy EI, Sauvageau E, Hanel RA, Hopkins LN. Current concepts in the management of intracranial atherosclerotic disease. Neurosurgery 2006; 59(5 Suppl 3): 210–218.

25. Levy EI, Mehta R, Gupta R, Hanel RA, Chamczuk AJ, Fiorella D, et al. Self-expanding stents for recanalization of acute cerebrovascular occlusion. AJNR Am J Neuroradiol 2007; 28: 816–822.

26. Benes V, Netuka D, Charvat F, Mohapl M. Recanalization of long-lasting middle cerebral artery occlusion by a combination of surgical and interventional approaches: technical case report. Neurosurgery 2005; 57(4 Suppl): E401.

27. Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI. A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 2000; 21: 643–646.

28. Bose A, Hartmann M, Henkes H, Liu HM, Teng MM, Szikora I et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 2007; 38: 1531–1537.

29. Charvát F, Mašková J, Beneš V, Kramář F. Použití intrakraniálních stentů v endovaskulární léčbě mozkových aneuryzmat. Cesk Slov Neurol N 2006; 69/102(3): 211–216.

30. Fiorella D, Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B et al. US multicenter experience with the wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results. Stroke 2007; 38: 881–887.

Paediatric neurology Neurosurgery Neurology
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