Cerebrovascular angioplasty and stenting for the prevention of stroke

Until recently, stroke preventive strategies have focused on either medical regimens aimed at antagonizing or reversing atherosclerosis, or surgical intervention for revascularization of the cerebrovascular system. However, with the advent of rapidly emerging microcatheterization techniques and technology, endovascular surgical revascularization of the brain is rapidly emerging as a powerful therapeutic modality. In particular, significant advances already have been made in revascularization of the extracranial carotid artery and many common anatomic sites of intracranial athero-occlusive disease, using special adaptations of conventional percutaneous angioplasty and stenting techniques. This paper reviews the cumulative experience with these emerging techniques, with a particular emphasis on clinical outcomes and future directions. It also reports the substantial cumulative institutional experience of the authors over the past 18 months with both extracranial carotid and intracranial artery stent-assisted carotid angioplasty.