A Prospective Single Center Study to Evaluate Safety and Short-term Efficacy of Angioplasty and Stent Placement for Intracranial Atherosclerotic Disease
Background and Purpose:Intracranial atherosclerotic disease (ICAD) is associated with a 7% to 10% annual incidence of ischemic stroke. Although percutaneous transluminal angioplasty (PTA) has been introduced for revascularization of ICAD, the treatment experience is limited. We prospectively studied the safety and efficacy of PTA and/or stent placement for ICAD at a tertiary-care referral hospital. Methods:Each patient was evaluated by a neurologist prior to, immediately following and 24 hours after the procedure. PTA and/or stent placement were performed using routine techniques as either single or multiple procedures. Any complications related to the procedure in 1-month interval were recorded. Pre- and post-angiograms were analyzed to evaluate response to endovascular revascularization. Results:A total of 25 patients (29 procedures) were treated (mean age 62.6 ± 12.6 years) for ≥ 50% stenosis in the internal carotid artery (n=4), middle cerebral artery (n=8), vertebral artery (n=11), or basilar artery (n=2). The procedures included PTA (n=20), primary stenting (n=8), or combination of both (n=1). There was an improvement in stenosis (mean ±SD) from 85 ±13% to 23.8 ±23.4%. The overall stroke rate per procedure was 6%; all strokes were minor. One patient died from post-procedural intracerebral hemorrhage. Systemic bleeding complications were observed in 6% of the procedures (3% major and 3% minor). Conclusions:Endovascular revascularization for treatment of ICAD appears to be feasible with a low complication rate. Further studies are required to evaluate the long-term efficacy of these procedures in reducing the risk of ischemic stroke in patients with ICAD.