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Balloon angioplasty of intracranial arteries for stroke prevention
1Stroke Service, Centennial Medical Center, Nashville, TN 37203, USA.
Insights
Balloon angioplasty offers a new treatment for preventing strokes caused by surgically inaccessible intracranial atherostenosis. This endovascular procedure showed success in stabilizing plaques and preventing restenosis in a small patient group.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Surgically inaccessible intracranial atherostenosis poses a significant stroke risk.
- Current medical therapies like antithrombotics have limitations in preventing plaque progression.
- Patients with isolated cerebral circulations are particularly vulnerable to stroke from stenosis.
Purpose of the Study:
- To evaluate the efficacy and safety of balloon angioplasty for secondary stroke prevention in patients with intracranial atherostenosis.
- To assess the feasibility of endovascular treatment when medical management fails.
Main Methods:
- Fifteen patients with atherosclerotic intracranial stenoses underwent balloon angioplasty after warfarin therapy failure.
- Angioplasty targeted stenotic lesions in the distal internal carotid, middle cerebral, vertebral, and basilar arteries.
- Follow-up included assessment for transient ischemic attacks and restenosis over 24 months.
Main Results:
- Successful dilation was achieved in all treated intracranial vessels, with residual stenosis averaging less than 30%.
- No recurrence of transient ischemic attacks or restenosis was observed during the follow-up period.
- Two complications occurred: one pontine stroke and one fatal vessel rupture.
Conclusions:
- Balloon angioplasty is a potential therapeutic option for secondary stroke prevention in carefully selected patients with intracranial atherostenosis.
- Endovascular treatment demonstrated promising results in preventing restenosis and stroke recurrence.
- Larger studies are needed to confirm the safety and efficacy of this endovascular approach.
Abstract:
Stroke from surgically inaccessible intracranial atherostenosis remains a formidable clinical challenge. While antithrombotic or antiplatelet therapy may prevent distal embolism, there is no effective program for plaque stabilization preventing progression of atherosclerotic stenosis. In patients with isolated circulations (single vertebral with absent posterior communicating arteries, single carotid with contralateral internal carotid artery occlusion, or single carotid with an absent anterior communicating artery), occlusion of the stenotic vessel may produce a low flow-mediated stroke. Fifteen patients with atherosclerotic intracranial stenoses were treated by balloon angioplasty after medical therapy with warfarin failed. Treated territories included the distal internal carotid, proximal middle cerebral, distal vertebral, and basilar arteries. Dilation was successful in all vessels, with residual stenoses averaging less than 30%. Two complications included one paramedian pontine stroke and a single vessel rupture that proved fatal. There was no recurrence of transient ischemic attacks and no restenosis at the angioplasty site over a follow-up period of more than 24 months. In this small series, balloon angioplasty of intracranial vessels provided a therapeutic option for secondary stroke prevention in highly selected patients. Further studies will be necessary to establish the efficacy and safety of endovascular treatment in larger series.