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The correction of cerebrovascular insufficiency by transluminal dilatation: a preliminary report
Insights
Transluminal angioplasty effectively treated cerebral ischemia caused by extracranial arterial stenosis in 10 patients. This minimally invasive procedure improved blood flow and relieved symptoms, showing promise for managing cerebrovascular insufficiency.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Medicine
Background:
- Cerebrovascular insufficiency due to extracranial arterial stenosis is a significant clinical challenge.
- Transluminal angioplasty is established for peripheral arteriosclerosis but less so for cerebrovascular applications.
Purpose of the Study:
- To evaluate the safety and efficacy of transluminal angioplasty for treating cerebral ischemia caused by extracranial arterial stenosis.
Main Methods:
- Ten patients with symptoms of vertebrobasilar insufficiency underwent arteriography.
- Significant subclavian and innominate artery stenoses were identified.
- Transluminal angioplasty was performed via retrograde catheterization through surgically exposed arteries under fluoroscopic guidance.
Main Results:
- Successful anatomic correction of all arterial lesions was achieved without complications.
- Mean brachial systolic pressure increased by 38.2 mm Hg post-angioplasty.
- Seven patients experienced total symptomatic relief, two partial relief, and one no relief, with follow-up averaging 13 months.
Conclusions:
- Transluminal angioplasty is a safe and effective treatment for selected patients with cerebral ischemia secondary to extracranial arterial stenosis.
- The procedure demonstrated significant improvement in hemodynamics and initial symptom resolution.
- One case of recurrent stenosis highlights the need for ongoing monitoring.
Abstract:
Transluminal angioplasty is being extensively utilized to dilate arteriosclerotic lesions. However, this technique has not been widely used for the treatment of cerebrovascular insufficiency. This report describes the application of transluminal angioplasty to relieve cerebral ischemia secondary to extracranial arterial stenosis. A total of 10 patients presented with symptoms of vertebrobasilar insufficiency. Bilateral upper extremity pressures were measured prior to the performance of arteriography on all patients. Significant stenoses were found in the subclavian artery (9) and in the innominate artery (1). Dilating catheters were passed retrograde through surgically exposed brachial and common carotid arteries. Transluminal angioplasty under fluoroscopic control was attempted. Anatomic correction of all lesions was achieved without hemorrhagic or embolic complications. The mean increase in brachial systolic pressure was 38.2 mm Hg postdilatation. Initial symptomatic relief was total in seven patients, partial in two, and absent in one. It is believed that associated small vessel brain stem disease accounted for the less than total relief of symptoms of these three patients. Average follow-up for all patients was 13 months with one recurrent subclavian artery stenosis occurring at three months postangioplasty. Preliminary results suggest that some patients with cerebral ischemia secondary to extracranial arterial stenosis can be treated safely by transluminal angioplasty.
