Percutaneous transluminal angioplasty for intracranial arteriosclerotic lesions

Recent developments of the interventional neuroradiological technique made percutaneous transluminal angioplasty (PTA) possible even for intracranial arteries(1). We report our experiences of 17 cases treated by PTA including 9 intracranial internal carotid (ICA), 4 middle cerebral (MCA) and 4 vertebro-basilar arterial (VBA) stenoses and discuss the problems of the procedure. All patients had cerebral ischemic symptoms and stenoses more than 60% calculated angiographically. Three of them were treated by PTA for residual stenoses after thrombolytic therapy for acute occlusion. We used PTA balloon catheters 2.0 mm to 3.5 mm in diameter (Stealth, Target therapeutics) for all PTA procedures. A PTA balloon was inflated for 1 min at 6 atm as a rule. All were successfully dilated (stenosis less than 50%) except one treated by PTA for residual MCA stenosis after thrombolytic therapy. The patient died from massive infarction due to MCA re-occlusion caused by MCA dissection. Restenosis appeared in 4 of 16 patients. Repeated PTA was successfuly carried out for the 4 patients. However, restenosis appeared in one of them but the patient is now on follow-up because of asymptomatic course. PTA for intracranial arteries is an effective treatment but its indication should be determined strictly because of potential risk such as acute occlusion derived from dissection.