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Published on: January 23, 2019
Primary angioplasty for a subtype of symptomatic middle cerebral artery stenosis
Zhongrong Miao1, Bin Wang, Lei Feng
1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People's Republic of China.
Insights
Primary balloon angioplasty effectively prevented stroke in specific middle cerebral artery stenosis patients long-term. While safe and durable, dissection remains a technical challenge.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Symptomatic middle cerebral artery (MCA) stenosis poses a stroke risk.
- Revascularization strategies aim to prevent future ischemic events.
- Primary balloon angioplasty is an alternative to stenting in select MCA stenosis cases.
Purpose of the Study:
- To evaluate the long-term efficacy of primary balloon angioplasty for MCA revascularization.
- To assess stroke prevention in patients with specific MCA stenosis subtypes.
Main Methods:
- Retrospective analysis of 33 patients with symptomatic MCA stenosis treated with balloon angioplasty.
- Inclusion criteria: >70% stenosis, short/bifurcation lesions, tortuous vessels.
- Follow-up ranged from 6 to 60 months, assessing technical success, complications, and outcomes.
Main Results:
- Mean stenosis reduced from 87.12% to 23.03% post-angioplasty.
- Periprocedural complication rate was 18.18% (dissections without ischemia).
- Five-year stroke-free survival was 90.04%; two strokes occurred at 6 and 32 months.
Conclusions:
- Primary balloon angioplasty appears safe and provides durable stroke prevention in selected MCA stenosis patients.
- Dissection remains a significant technical drawback.
- Long-term follow-up confirms the potential of this revascularization technique.
Introduction:
The purpose of this study was to assess the long-term efficacy of middle cerebral artery revascularisation by primary balloon angioplasty for the prevention of stroke in a certain subtype of patients.
Method:
A retrospective study was performed to evaluate 33 patients with symptomatic middle cerebral artery stenoses who underwent primary balloon angioplasty; the selection criteria were: greater than 70% stenosis measured by digital subtraction angiography, lesions equal to or shorter than 5 mm, lesions near or across a bifurcation, and lesions with very tortuous proximal vessels that increase the risk of stenting. All patients were available for follow-up ranging from 6 to 60 months. The technical success rate, periprocedural complications, and long-term outcome were retrospectively reviewed.
Result:
The mean stenosis degree was reduced from 87.12 ± 7.40 to 23.03 ± 9.84 after angioplasty. The periprocedural complication rate was 18.18% (six dissections without an ischemic event). Two patients had strokes in the territory of the angioplasty at 6 and 32 months after angioplasty, and the stroke-free survival at 5 years was 90.04% (mean survival time, 56.42 ± 2.43 months; 95% CI, 51.66-61.19 months).
Conclusion:
These results suggest that this treatment is safe and could provide a durable clinical result at long-term follow-up in this subtype of patients, but the high rate of dissection remains a major technical drawback.
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