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Balloon Angioplasty for Intracranial Atherosclerotic Disease: A Multicenter Study
Lakshmi Sudha Prasanna Karanam1, Mukesh Sharma2, Anand Alurkar3
1Lalitha Super Speciality Hospital, Guntur, Andhra Pradesh, India.
Insights
Balloon angioplasty effectively treats intracranial atherosclerotic disease (ICAD) in stroke patients. This safe procedure shows promising outcomes for acute stroke and symptomatic ICAD, with low restenosis rates.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Medicine
Background:
- Intracranial atherosclerotic disease (ICAD) poses a significant risk for stroke.
- Optimal medical management for symptomatic ICAD may not always prevent recurrent ischemic events.
Purpose of the Study:
- To evaluate the efficacy and safety of balloon angioplasty for ICAD.
- To assess outcomes in patients with acute stroke due to vessel occlusion and symptomatic ICAD despite medical management.
Main Methods:
- 39 patients with ICAD underwent balloon angioplasty (Maverick balloon catheter) between 2013-2016.
- Patients included those with acute stroke (n=23) and symptomatic ICAD (n=16).
- Technical success, peri-procedural events, and clinical outcomes were documented.
Main Results:
- Technical success (residual stenosis <50%) was achieved in 37 patients.
- Mortality was 2% (one disabling stroke due to reocclusion, one death from hemorrhage).
- No restenosis was observed in 26 patients at nine-month follow-up MR angiogram.
Conclusions:
- Balloon angioplasty is a safe and effective treatment option for ICAD.
- The procedure demonstrates promising outcomes for patients with acute stroke and symptomatic ICAD.
- Acceptable risks are associated with balloon angioplasty in managing ICAD.
Aim:
To evaluate the role and efficacy of the balloon angioplasty in intracranial atherosclerotic disease (ICAD) in patients who presented with acute stroke due to vessel occlusion and in patients with symptomatic disease despite optimum medical management.
Methods:
From 2013 to 2016, a total of 39 patients (24 males and 15 females with a mean age of 64.5 years) underwent balloon angioplasty over a period of 2 years and 8 months in three different institutions in India. Maverick balloon catheter (Boston scientific) is used in all the patients. MRI brain with MR angiogram was done in all the patients prior to intervention. Twenty-three patients who had underlying severe ICAD presented with acute stroke due to vessel occlusion. Sixteen patients presented with symptomatic ICAD with recurrent ischemic attack due to the progressing underlying disease despite optimum medical management. Technical success, peri-procedural events, and clinical outcomes were documented for all the patients.
Results:
Technical success (residual stenosis < 50%) was achieved in 37 cases. Extra cranial carotid stenting was required in 2 patients. In patients with acute stroke presentation (NIHSS score median of 16.5), adjuvant intravenous and intra-arterial tissue plasminogen activator were given in 8 and 3 patients, respectively, and mechanical thrombectomy (MT) with solitaire was used in 15 patients. Patients who underwent MT in acute stroke without ICAD were not included in the study. Reocclusion occurred in one patient who developed disabling stroke and one patient died of intra-cerebral hemorrhage. Thus, the mortality of this study is 2%. Clinical outcome was assessed based on mRS. One-month, three-month, and six-month follow-up was available in >90% of the patients. MR angiogram on follow-up of nine months was done in 26 patients, and none of them had restenosis.
Conclusion:
Balloon angioplasty is a safe option and can be effectively used in patients of ICAD with acceptable risks and promising outcomes.
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