[Stent-assisted angioplasty using the proximal protection method for intracranial internal carotid artery stenosis]

Percutaneous transluminal angioplasty (PTA) with stenting (PTA/stenting) for intracranial atherosclerotic stenoses is usually performed without any embolic protection devise (EPD). However, we have encountered ischemic complications when performing PTA/stenting without EPD for symptomatic intracranial internal carotid artery stenosis. We report here a case of symptomatic intracranial artery stenosis, which was treated by stenting under proximal protection without ischemic complications. The 54-year-old male was admitted to our hospital complaining of motor weakness. Diffusion-weighted image (DWI) in MRI revealed multiple high intensity lesions in the left frontal and parietal lobe. An angiogram demonstrated 80% stenosis in the C5 portion of the left internal carotid artery. PTA/stenting was performed using an occlusion catheter under proximal protection. The occlusion catheter with balloon was placed in the left internal carotid artery of the cervical segment. The balloon was inflated to intercept blood flow, and a driver stent was placed following PTA. Postoperative angiography demonstrated that the degree of stenosis had decreased to almost 5% after PTA/stenting. The patient did not present other neurological deficits. MRI-DWI did not reveal any ischemic lesions following the treatment. PTA/stenting under proximal protection using an occlusion catheter is a simple technique, and is considered to be effective for intracranial internal carotid stenosis.