Angioplasty and stenting of intracranial stenosis

The review summarizes recent advances in angioplasty and stenting of intracranial atherosclerotic stenosis.

Several single-center studies show that, with the technological advancements in device technology, intracranial stenting is feasible even in the distal internal carotid artery or middle cerebral artery. However, the clinical outcomes vary between moderate and high risk rates for morbidity and mortality. To date, the only prospective multi-center study that has been conducted is the SSYLVIA (Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries) study, which demonstrated stroke rates of 6.6% and 13.1% at 30 days and 1 year, respectively. A unique feature of this trial is the assessment of restenosis rates and their potential association with clinical symptoms and risks. A promising new concept for stent-assisted procedures in the intracranial vasculature is the use of self-expanding stents. The high flexibility of these stents makes them suitable for treatment of lesions of the distal internal carotid artery and middle cerebral artery that are either inaccessible or difficult to reach with a balloon-mounted stent. Additionally, these self-expanding stents may result in fewer traumas to the parent vessel and in reduced rates of iatrogenic complications and restenosis.

Intracranial angioplasty with or without stenting is a promising treatment option. Patient selection, careful periprocedural medical management, and a highly skilled neuroendovascular surgeon are all required to perform the procedure with an acceptable risk. If stenting is to be shown to be a safe therapeutic alternative, prospective trials comparing stenting with optimal medical treatment need to be performed.