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Recanalization results after intracranial stenting of atherosclerotic stenoses
Stella Blasel1, Zeynep Yükzek, Wiebke Kurre
1Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. Stella.Blasel@kgu.de
Insights
Balloon-expandable stents effectively treat high-grade intracranial stenosis, achieving significant luminal gain with few major complications. However, suboptimal results like incomplete stent apposition can still occur.
Area of Science:
- Neurology
- Interventional Radiology
- Cardiovascular Medicine
Background:
- High-grade intracranial stenosis poses a significant risk for stroke.
- Endovascular treatment with stenting is a therapeutic option.
- Balloon-expandable stents offer a method for treating these stenotic lesions.
Purpose of the Study:
- To detail the angiographic outcomes of intracranial stenting for high-grade stenosis.
- To evaluate the efficacy and safety of balloon-expandable stents in this context.
- To assess morphologic criteria post-stenting, including stent apposition and vessel wall changes.
Main Methods:
- Forty patients with symptomatic atherosclerotic intracranial stenosis (>50%) underwent stenting.
- Balloon-expandable stents were used with a specific technique of slight underdilation.
- Angiographic assessment before and after stenting evaluated stenosis degree and morphological features.
Main Results:
- Mean stenosis decreased from 76.2% to 20.8% post-stenting.
- Technical success rate was 95% with no major vessel complications.
- Minor abnormalities included incomplete stent apposition (20%), plaque coverage (17.5%), side branch compromise (32.5%), and minor dissections (5%).
Conclusions:
- Intracranial stenting with slight underdilation provides reliable luminal gain and avoids major complications.
- Suboptimal recanalization results were observed in a significant proportion of cases.
- These suboptimal results may contribute to individual neurological complications.
Abstract:
The purpose of this investigation was to provide a detailed description of the angiographic results after stenting of high-grade intracranial stenosis using balloon-expandable stents. Forty consecutive patients with symptomatic atherosclerotic intracranial stenosis >50% received endovascular treatment by placement of balloon-expandable stents using the concept of slight underdilation and strict avoidance of overdilation. Intra-arterial digital subtraction angiography images before and after stenting in the same projection were reviewed for pre- and post-therapeutic measurement of the degree of stenosis and evaluation of morphologic criteria like plaque coverage, stent apposition, patency of side branches, and signs of dissection or vasospasm. Stenting decreased the mean percentage stenosis from 76.2 (WASID criteria) to 20.8%. Residual stenosis ranged from 0 to 55% with residual stenosis >50% in two of 40 cases. Technical success rate was 95%. There were no major vessel complications, but minor abnormalities like incomplete stent apposition (8/40) or plaque coverage (7/40), incomplete filling of side branches (13/40), and minor dissections after stenting (2/40) were seen. One case with incomplete stent apposition and two cases with side branch compromise were associated with clinical symptoms. In conclusion, intracranial stenting with slight underdilation avoided major vessel complication and created reliable luminal gain. Suboptimal recanalization results were frequently detected and may be the source of neurological complications in individual cases.
