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Percutaneous transluminal angioplasty for symptomatic middle cerebral artery stenosis: long-term follow-up
Ju H Lee1, Sun U Kwon, Jae H Lee
1Department of Neurology, College of Medicine, Hallym University, Seoul, South Korea.
Insights
Percutaneous transluminal angioplasty (PTA) for symptomatic middle cerebral artery (MCA) stenosis is safe and can prevent recurrent TIAs. Restenosis occurred in 50% of patients, but PTA remains a viable option for selected individuals.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Medicine
Background:
- Percutaneous transluminal angioplasty (PTA) is established for coronary and peripheral arteries.
- Efficacy of PTA for intracranial atherosclerotic stenosis remains unverified.
- Symptomatic middle cerebral artery (MCA) stenosis poses a risk for stroke and TIA.
Purpose of the Study:
- To assess the long-term outcomes of PTA in patients with symptomatic MCA stenosis.
- To evaluate the safety and efficacy of PTA in preventing recurrent ischemic events.
Main Methods:
- PTA was performed using a microballoon without stenting in 10 patients with >70% MCA stenosis.
- Patients had recurrent TIAs or perfusion issues despite medical therapy.
- Restenosis was defined as >50% stenosis or increased M1 flow velocity on follow-up.
Main Results:
- Successful PTA in 9/10 patients; one had asymptomatic dissection.
- Residual stenosis <50% in all treated patients.
- Recurrent TIAs ceased in 6/7 patients; 3/6 patients developed restenosis (50%).
Conclusions:
- PTA for symptomatic MCA stenosis is relatively safe.
- Restenosis is a potential complication but does not preclude successful treatment.
- PTA can be considered for selected patients to prevent recurrent TIAs or strokes.
Background And Objective:
Although percutaneous transluminal angioplasty (PTA) is an effective treatment modality in the coronary and peripheral arterial diseases, its efficacy for intracranial atherosclerotic stenosis has not been verified. We assessed the long-term outcome of PTA for symptomatic middle cerebral artery (MCA) stenosis.
Methods:
We performed PTA in 10 patients with symptomatic high-grade stenosis (>70%) on M1 segment of MCA, who had either recurrent transient ischemic attacks (TIAs) resistant to medical therapy or perfusion problems. PTA was performed with a microballoon (2-2.5 mm diameter and 10-13 mm length) without insertion of a stent. After PTA, we evaluated the possible occurrence of restenosis, which was defined as >50% stenosis on follow-up conventional angiogram or increased M1 flow velocity on follow-up transcranial doppler up to the baseline value.
Results:
PTA was successfully performed in 9 patients without any serious complications. One patient had asymptomatic dissection. Residual stenosis was less than 50% in diameter in all the patients. During follow-up period (mean 34.5 months), TIAs did not recur in 6 of 7 patients who had had intractable TIAs. Two patients developed strokes, which were not referable to the index MCA lesions. Among the 6 patients who underwent follow-up conventional angiography or serial TCD, restenosis was noticed in 3 patients (50%).
Conclusion:
Although restenosis is not uncommon, PTA for symptomatic MCA stenosis is a relatively safe procedure, and can be used to prevent recurrent TIAs or strokes in selected patients.
