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Intracranial percutaneous transluminal angioplasty for arteriosclerotic stenosis
A Alazzaz1, J Thornton, V A Aletich
1Department of Neurosurgery, University of Illinois at Chicago, MC 799, 912 S Wood St, Chicago, IL 60612, USA.
Insights
Percutaneous transluminal angioplasty offers a viable treatment for intracranial arteriosclerotic disease when medical or surgical options fail. This procedure shows promise for selected patients, achieving good outcomes with relatively low risks.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Intracranial arteriosclerotic disease presents significant morbidity and mortality.
- Some patients are unresponsive to medical treatment or face high surgical risks.
Purpose of the Study:
- To evaluate the effectiveness and safety of percutaneous transluminal angioplasty (PTA) for intracranial stenosis.
- To summarize procedural outcomes and patient data.
Main Methods:
- Sixteen patients with high-grade arteriosclerotic stenosis underwent intracranial PTA.
- Procedures targeted vertebral, basilar, middle cerebral, and internal carotid arteries.
- Strict inclusion/exclusion criteria were applied.
Main Results:
- Successful vessel caliber increase (>80% or 50-70% of normal) in 12 patients, with symptom reduction.
- Complications included 1 treatment failure, 3 intimal dissections (1 stented), and 1 restenosis.
- Two strokes occurred (1 mild, 1 severe); no mortality.
Conclusions:
- Percutaneous transluminal angioplasty is an attractive alternative for managing intracranial arteriosclerotic disease in select patients.
- It offers a relatively low-risk option with good clinical outcomes for those unresponsive to medical therapy or with surgical contraindications.
Background:
Patients with intracranial arteriosclerotic disease have significant morbidity and mortality rates, and some are unresponsive to medical treatment and have unacceptable surgical risks. Percutaneous transluminal angioplasty of the intracranial vessels is a possible alternative to surgery.
Objectives:
To present our experience with percutaneous transluminal angioplasty and to summarize our data.
Patients And Methods:
Sixteen patients underwent intracranial percutaneous transluminal angioplasty for high-grade arteriosclerotic stenosis based on strict inclusion and exclusion criteria. All patients had symptoms referable to the stenosis except one. Angioplasty was performed in 6 intracranial vertebral arteries, 3 basilar arteries, 5 middle cerebral arteries, and 3 distal internal carotid arteries. One patient had concomitant stent placement.
Results:
There was 1 treatment failure secondary to tortuous vascular anatomy. Vessel caliber was increased to more than 80% of normal in 6 patients and to 50% to 70% of normal in 6 patients, with a reduction of symptoms. Three intimal dissections occurred during angioplasty; one of these, in a precavernous segment of the internal carotid artery, was stented. One patient restenosed within 1 month of treatment. The remaining treated arteries remained patent during follow-up of 3 months to 2 years. Stroke as a complication occurred in 2 patients, 1 mild and 1 severe. There was no mortality.
Conclusions:
Occlusive arteriosclerotic disease involving the intracranial cerebral vessels can be managed medically with antiplatelet and anticoagulant drug therapy or surgically. However, in patients who are unresponsive to medical therapy or who have unacceptable surgical risks, percutaneous transluminal angioplasty is an attractive alternative that can be performed in selected patients with relatively low risk and good clinical outcome.