Intracranial stenting of atherosclerotic stenoses: current status and perspectives

The purpose of this review article is to give an overview of the current development of intracranial stenting for treatment of atherosclerotic stenoses. Natural history and methods for diagnostic imaging are described as basis for the indication for endovascular treatment. Target group are patients with high-grade symptomatic stenoses > 70%. Technical standards for the use of self-expanding and balloon-expandable stents are reported together with the results of clinical case series. It seems to be difficult to drop acute complication rates (procedure-related stroke and death during the first 30 days) reliably from current levels of around 10% to values < 6%, which are more acceptable for a prophylactic procedure for the prevention of stroke. High restenosis rates up to 30% in the 1st year raised concerns about long-term efficacy. Further technical developments and improved criteria for patient selection are necessary to make intracranial stenting safer and more effective before a randomized trial (stent vs. medical treatment) may prove superiority of the endovascular approach.