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The Role of Angioplasty Alone in Intracranial Atherosclerosis: 2-Dimensional Operative Video
Salomon Cohen-Cohen1, Giuseppe Lanzino1, Waleed Brinjikji2
1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Intracranial atherosclerosis disease (IAD) can cause stroke. Submaximal angioplasty (SA) effectively revascularized a patient with internal carotid artery occlusion, improving neurological function.
Area of Science:
- Neurology
- Vascular Neurology
- Interventional Neurology
Background:
- Intracranial atherosclerosis disease (IAD) accounts for up to 10% of strokes.
- Symptomatic IAD often results from hypoperfusion, embolism, or occlusion.
- Treatment options include medical management, surgery, and endovascular therapies.
Purpose of the Study:
- To present a case of acute ischemic stroke due to internal carotid artery occlusion treated with submaximal angioplasty (SA).
- To evaluate the efficacy and safety of SA in managing symptomatic IAD.
Main Methods:
- A 62-year-old male with acute ischemic stroke in the right middle cerebral artery territory underwent initial treatment with tissue plasminogen activator (tPA).
- Cerebral angiography with thrombectomy and submaximal angioplasty (SA) was performed for internal carotid artery occlusion.
- Imaging included CT angiography (CTA), CT perfusion (CTP), and MRI.
Main Results:
- Successful revascularization of the right internal carotid artery was achieved.
- The patient experienced improvement in neurological examination post-procedure.
- No procedure-related complications were observed.
Conclusions:
- Submaximal angioplasty (SA) is an efficient and potentially safer alternative to conventional angioplasty or stenting for symptomatic IAD.
- Endovascular treatment, including SA, can be effective in managing complex intracranial atherosclerosis leading to stroke.
Abstract:
Intracranial atherosclerosis disease (IAD) is the cause of stroke in up to 10% of cases. Symptomatic IAD results mainly from hypoperfusion, embolic phenomenon, and occlusion. Treatment consists of conservative management with aggressive medical treatment, surgery, and endovascular therapy.1,2 This video is about a 62-yr-old male who presented with left-sided hemiparesis and right gaze preference secondary to an acute ischemic stroke in the right middle cerebral artery (MCA) territory treated initially with tissue plasminogen activator (tPA). Head computed tomography (CT) angiography (CTA) revealed occlusion of the extracranial and cavernous segments of the internal carotid artery (ICA). CT perfusion (CTP) showed hypoperfusion in the MCA territory and magnetic resonance imaging (MRI) revealed multifocal, wedge-shaped areas of restricted diffusion in the right hemisphere. During his hospitalization, he experienced worsening of his symptoms in the setting of hypoperfusion (hypotension). The patient underwent a cerebral angiogram with thrombectomy and submaximal angioplasty (SA). Successful revascularization of the right ICA was obtained. No procedure-related complications occurred, and the patient's neurological exam improved. SA can be as efficient and a safer option than conventional angioplasty or angioplasty and stenting for symptomatic IAD. The patient consented for the procedure and for the video production.
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