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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis

R Gupta1, H C Schumacher, S Mangla

  • 1Department of Neurology, New York Presbyterian Hospital, Columbia University, New York, NY 10032, USA.

Neurology
|December 25, 2003
PubMed

Insights

Endovascular revascularization for intracranial atherosclerotic stenoses is feasible but carries high complication rates in neurologically unstable patients. Careful patient selection and management are crucial for improving outcomes in this high-risk group.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Vascular Surgery

Background:

  • Endovascular revascularization for intracranial atherosclerotic stenoses is increasingly performed.
  • This procedure is considered technically feasible and safe in major medical centers.
  • This study reports on patients undergoing revascularization for impending stroke and neurologic instability.

Purpose of the Study:

  • To evaluate the safety and efficacy of endovascular revascularization for intracranial atherosclerotic stenoses.
  • To assess outcomes in patients with impending stroke and neurologic instability.

Main Methods:

  • Retrospective review of 18 patients (21 lesions) treated between 1997 and 2002.
  • Patients had failed maximal medical therapy and were at high risk for imminent stroke.
  • Procedures included angioplasty for lesions in the internal carotid, middle cerebral, vertebral, and basilar arteries.

Main Results:

  • Recanalization was achieved in 19 of 21 lesions (TIMI Grade III or II).
  • Major periprocedural complications occurred in 50% of patients, including intracranial hemorrhage (17%) and disabling ischemic stroke (11%).
  • Mortality rate was 17%, with deaths due to intracerebral hemorrhage and cardiorespiratory failure.

Conclusions:

  • Endovascular revascularization of intracranial vessels is technically feasible.
  • Periprocedural complication and fatality rates are high in neurologically unstable patients.
  • Patient selection, procedural timing, and medical management are critical for reducing morbidity and mortality.
Abstract

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