Percutaneous transluminal angioplasty and stenting for severe stenosis of the intracranial extradural internal carotid artery causing transient ischemic attack or minor stroke.

Abstract

The purpose of this study is to assess the technical feasibility and clinical efficacy of percutaneous transluminal angioplasty and stenting (PTAS) for symptomatic stenosis of the intracranial extradural (petrous and cavernous) internal carotid artery (ICA).Review of medical records identified 26 consecutive patients who underwent PTAS using a balloon-expandable coronary stent (n = 15, 57.7%) or a Wingspan self-expandable stent (n = 11, 42.3%) for treatment of severe stenosis (>70%) involving the intracranial extradural ICA. The inclusion criteria were transient ischemic attack with an ABCD(2) score of ≥3 (n = 12, 46.2%) or minor stroke with an NIHSS score of ≤4 (n = 14, 53.8%). Technical success rates, complications, and angiographic and clinical outcomes were analyzed retrospectively.PTAS was technically successful in all patients. The mean stenosis ratio decreased from 77.1% to 10.0% immediately after PTAS. The overall incidence of procedural complications was 23.1%, and the postoperative permanent morbidity/mortality rate was 7.7%. A total of 22 patients were tracked over an average period of 29.9 months. During the observation period, 20 patients (90.9%) had no further cerebrovascular events and stroke recurrence occurred in two patients (9.1%), resulting in an annual stroke risk of 3.7%. Two cases (11.1%) of significant in-stent restenosis (>50%) were found on follow-up angiography (n = 18).PTAS for severe stenosis (>70%) involving the intracranial extradural ICA showed a good technical feasibility and favorable clinical outcome in patients with transient ischemic attack or minor stroke.

• Authors: Jun Kyeung Ko, Chang Hwa Choi, Seung Heon Cha, Byung Kwan Choi, Won Ho Cho, Tae Ho Kang, Sang Min Sung, Han Jin Cho, Tae Hong Lee
• Journal: Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences (Interv Neuroradiol) Vol. 21 Issue 4 Pg. 511-9 (Aug 2015) ISSN: 2385-2011 [Electronic] United States
• PMID: 26063697 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2015.

Topics

• Adult
• Aged
• Angioplasty (methods)
• Carotid Artery, Internal (diagnostic imaging, surgery)
• Carotid Stenosis (complications, diagnostic imaging, surgery)
• Cerebral Angiography
• Feasibility Studies
• Female
• Follow-Up Studies
• Graft Occlusion, Vascular (epidemiology)
• Humans
• Ischemic Attack, Transient (diagnostic imaging, etiology)
• Male
• Middle Aged
• Neurosurgical Procedures (methods)
• Retrospective Studies
• Stents
• Stroke (diagnostic imaging, etiology)
• Treatment Outcome