| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Neuroradiology |
1 From the Institute of Neuroradiology (R.d.M.d.R., B.T., F.E.Z., J.B.) and Department of Neurology (M.B., M.S.), Johann Wolfgang Goethe-University Frankfurt, Schleusenweg 2–16, 60528 Frankfurt, Germany. Received February 4, 2003; revision requested April 23; final revision received September 5; accepted September 29. Address correspondence to R.d.M.d.R. (e-mail: mesnil@em.uni-frankfurt.de).
PURPOSE: To prospectively evaluate the safety and efficacy of undersized stents used in patients with high-grade intracranial stenosis and recurrent ischemic symptoms who are undergoing medical treatment.
MATERIALS AND METHODS: In 18 patients (13 men, five women; age range, 51–82 years), 20 high-grade (>70%) intracranial stenoses were selected for stent placement. All patients had transient ischemic symptoms or minor strokes while undergoing combined antithrombotic therapy with acetylsalicylic acid plus clopidogrel or anticoagulation therapy with warfarin or heparin plus acetylsalicylic acid. Technical success was defined as reaching the target lesion and deploying a stent, with a residual stenosis of less than 50%. The diameter of the stent was 0.5-mm smaller than the measured diameter of the normal adjacent vessel to avoid dissection and vessel rupture. Primary endpoints for safety evaluation were the combined incidence of death or major or minor stroke at 30 days; for efficacy evaluation, the primary endpoint was the incidence of any stroke in the treated vascular territory within the first 6 months. Statistical evaluation of the reduction of stenosis was performed.
RESULTS: In 18 of 20 stenoses, a stent was placed and the degree of stenosis was reduced from a median of 82% (range, 72%–97%) to a median of 16% (5%–40%; P < .001). The technical success rate was 90%. One patient had a parenchymal hemorrhage in a preexisting infarct on the 2nd day. Thus, the 30-day combined stroke and death rate was 6%. No immediate complication, thromboembolism, dissection compromising blood flow, or vessel rupture occurred during these procedures. Within the first 6 months after intervention, no patient had new ischemic symptoms in the treated vascular territory.
CONCLUSION: In selected patients with recurrent ischemic events due to high-grade intracranial stenosis, undersized stent placement holds promise as an effective and safe procedure.
© RSNA, 2004
Index terms: Brain, ischemia, 17.769 • Cerebral blood vessels, stenosis or obstruction, 172.721, 174.721, 175.721 • Cerebral blood vessels, transluminal angioplasty, 17.1269 • Cerebral blood vessels, US, 17.12989 • Stents and prostheses
This article has been cited by other articles:
|
|
 |
|
  F. Nahab, M. J. Lynn, S. E. Kasner, M. J. Alexander, R. Klucznik, O. O. Zaidat, J. Chaloupka, H. Lutsep, S. Barnwell, M. Mawad, et al. Risk factors associated with major cerebrovascular complications after intracranial stenting Neurology, June 9, 2009; 72(23): 2014 - 2019. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Groschel, S. Schnaudigel, S. M. Pilgram, K. Wasser, and A. Kastrup A Systematic Review on Outcome After Stenting for Intracranial Atherosclerosis Stroke, May 1, 2009; 40(5): e340 - e347. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. C. Schumacher, P. M. Meyers, R. T. Higashida, C. P. Derdeyn, S. D. Lavine, G. M. Nesbit, D. Sacks, P. Rasmussen, and L. R. Wechsler Reporting Standards for Angioplasty and Stent-Assisted Angioplasty for Intracranial Atherosclerosis Stroke, May 1, 2009; 40(5): e348 - e365. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr Secondary Prevention of Atherothrombotic Events After Ischemic Stroke Mayo Clin. Proc., January 1, 2009; 84(1): 43 - 51. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D.C. Suh, J.K. Kim, J.W. Choi, B.S. Choi, H.W. Pyun, Y.J. Choi, M.-H. Kim, H.R. Yang, H.I. Ha, S.J. Kim, et al. Intracranial Stenting of Severe Symptomatic Intracranial Stenosis: Results of 100 Consecutive Patients AJNR Am. J. Neuroradiol., April 1, 2008; 29(4): 781 - 785. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.-J. Jiang, X.-T. Xu, M. Jin, B. Du, K.-H. Dong, and J.-P. Dai Apollo Stent for Symptomatic Atherosclerotic Intracranial Stenosis: Study Results AJNR Am. J. Neuroradiol., May 1, 2007; 28(5): 830 - 834. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W.-J. Jiang, B. Du, T. W. Leung, X.-T. Xu, M. Jin, and K.-H. Dong Symptomatic Intracranial Stenosis: Cerebrovascular Complications from Elective Stent Placement Radiology, April 1, 2007; 243(1): 188 - 197. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Jiang, X. T. Xu, B. Du, K. H. Dong, M. Jin, Q. H. Wang, and N. Ma Comparison of elective stenting of severe vs moderate intracranial atherosclerotic stenosis Neurology, February 6, 2007; 68(6): 420 - 426. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Heye, G. Maleux, J. Van Loon, and G. Wilms Symptomatic Stenosis of the Cavernous Portion of the Internal Carotid Artery due to an Irresectable Medial Sphenoid Wing Meningioma: Treatment By Endovascular Stent Placement AJNR Am. J. Neuroradiol., August 1, 2006; 27(7): 1532 - 1534. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Circulation, March 14, 2006; 113(10): e409 - e449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. du Mesnil de Rochemont, B. Yan, F.E. Zanella, D.A. Rufenacht, and J. Berkefeld Conformability of balloon-expandable stents to the carotid siphon: an in vitro study. AJNR Am. J. Neuroradiol., February 1, 2006; 27(2): 324 - 326. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke, February 1, 2006; 37(2): 577 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Kasner, M. I. Chimowitz, M. J. Lynn, H. Howlett-Smith, B. J. Stern, V. S. Hertzberg, M. R. Frankel, S. R. Levine, S. Chaturvedi, C. G. Benesch, et al. Predictors of Ischemic Stroke in the Territory of a Symptomatic Intracranial Arterial Stenosis Circulation, January 31, 2006; 113(4): 555 - 563. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Yoon, J. J. Seo, K. H. Cho, M. K. Kim, B. C. Kim, M. S. Park, T. S. Kim, J. K. Kim, and H. K. Kang Symptomatic Middle Cerebral Artery Stenosis Treated with Intracranial Angioplasty: Experience in 32 Patients Radiology, November 1, 2005; 237(2): 620 - 626. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. M. Kessler, C. Mounayer, M. Piotin, L. Spelle, J. R. Vanzin, and J. Moret The Use of Balloon-Expandable Stents in the Management of Intracranial Arterial Diseases: A 5-Year Single-Center Experience AJNR Am. J. Neuroradiol., October 1, 2005; 26(9): 2342 - 2348. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Moftakhar, A. S. Turk, D. B. Niemann, S. Hussain, S. Rajpal, T. Cook, M. Geraghty, B. Aagaard-Kienitz, P. A. Turski, and G. C. Newman Effects of Carotid or Vertebrobasilar Stent Placement on Cerebral Perfusion and Cognition AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1772 - 1780. [Abstract] [Full Text] [PDF]
|
|
