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Follow-up study after percutaneous transluminal cerebral angioplasty
1Department of Neurosurgery, Kochi Medical School, Kohasu, Okou-cho, Nankoku City, Kochi 783, Japan.
Insights
Percutaneous transluminal cerebral balloon angioplasty (PTCBA) effectively reduces neurological symptoms in the short term. However, restenosis remains a significant factor limiting the long-term benefits of this procedure.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Cerebral artery stenosis poses a significant risk of stroke.
- Percutaneous transluminal cerebral balloon angioplasty (PTCBA) is a potential treatment for significant intracranial and extracranial artery stenosis.
Purpose of the Study:
- To evaluate the safety and efficacy of PTCBA for treating symptomatic extra- and intracranial arterial lesions.
- To investigate the procedural outcomes and long-term risks associated with PTCBA.
Main Methods:
- Retrospective analysis of 80 PTCBA procedures performed between March 1991 and February 1996.
- Inclusion of 74 clinically symptomatic patients with haemodynamically significant lesions (>70% diameter stenosis).
- Follow-up to assess cerebral events including death, stroke, surgery, or repeat angioplasty.
Main Results:
- Procedural and clinical success rates were both 81%.
- Ischaemic symptoms resolved completely in patients with successful dilatation.
- Angiographic restenosis rate at 3 months was 22%; 2-year risks for death/stroke and any cerebral event were 16% and 49%, respectively.
- Restenosis requiring repeat angioplasty was the most common initial cerebral event.
Conclusions:
- PTCBA demonstrates significant efficacy in alleviating recurrent neurological symptoms, offering favorable short-term outcomes.
- Restenosis is a primary limitation impacting the long-term benefits of PTCBA for cerebral artery stenosis.
Abstract:
The purpose of this study was to assess the safety and efficacy of percutaneous transluminal cerebral balloon angioplasty (PTCBA) of extra- and intra-cranial arteries by investigating procedural outcome. Eighty haemodynamically significant extra- and intra-cranial lesions (% diameter stenosis > 70) in 74 clinically symptomatic patients were treated by elective and initial PTCBA between March 1991 and February 1996 and thereafter followed. Death, stroke, surgery, or repeated angioplasty of restenosis or new lesions were regarded as cerebral events after the initial PTCBA. The procedural and clinical success rates were 81 % (65 of 80) and 81 % (60 of 74), respectively. Progressively ischaemic symptoms disappeared completely after clinically successful dilatation. Angiographic restenosis rate at 3 months was 22 %(14 of 65). By life-table method, the death/stroke risk was 16 %, and any cerebral event risk was 49 % at 2 years following PTCBA, respectively. The most common of first cerebral events presented was repeated angioplasty of restenosis. In conclusion, PTCBA has great efficacy in decreasing recurrent neurological symptoms and produces a favourable short-term outcome, whereas restenosis limits long-term benefit.