Stenting for the treatment of high-grade intracranial stenoses

J Neurol. 2010 Nov;257(11):1899-908. doi: 10.1007/s00415-010-5633-1. Epub 2010 Jul 4.

Abstract

To date, evidence to recommend endovascular treatment in patients with intracranial stenoses is lacking. Recently, the introduction of self-expanding stents (Wingspan Stent System) aroused considerable expectations in their employ for stroke prevention. We report a single-center experience of percutaneous transluminal angioplasty and stenting in a series of consecutive patients with intracranial stenoses and compare the safety and performance of balloon-mounted stents versus self-expanding stent systems (Wingspan). Thirty-four patients with 39 severe (>70%) intracranial stenoses were treated during a 6-year period. An independent stroke neurologist collected data about intra and periprocedural complications and short-term outcome. We considered as endpoint measures (1) any 30-day stroke or death (2) any major 30-day complication and (3) procedure technical success. Technical success was achieved in all patients. No vessel dissection or ruptures were observed. The 30-day stroke/death rate was 17.9%. Five ischemic strokes in the territory of treated vessels and two intracranial hemorrhages occurred respectively within 24 h and 5 days after endovascular treatment. Three (17.6%) patients of Wingspan treated group and four (18.2%) of the patients treated with different stent systems had unfavorable outcome. Our study confirms that endovascular treatment can be performed with a high technical success rate, even though the safety of these devices has still to be demonstrated.

MeSH terms

  • Aged
  • Angioplasty / adverse effects
  • Angioplasty / instrumentation*
  • Angioplasty / methods
  • Constriction, Pathologic / surgery
  • Female
  • Humans
  • Intracranial Arteriosclerosis / surgery*
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Stents / adverse effects*
  • Stroke / prevention & control*
  • Treatment Outcome
  • Vascular Surgical Procedures / adverse effects
  • Vascular Surgical Procedures / instrumentation*
  • Vascular Surgical Procedures / methods