Safety and efficacy of percutaneous transluminal angioplasty for intracranial atherosclerotic stenosis.

Abstract

BACKGROUND AND PURPOSE:

Percutaneous transluminal angioplasty (PCTA) is increasingly used to treat extracerebral arterial stenosis. The present study evaluates the safety and efficacy of PCTA treatment of symptomatic intracranial atherosclerotic stenosis.

METHODS:

A series of 22 vessels in 17 patients were treated with PCTA. All patients had recurrent neurological symptoms referable to the stenotic vessel despite optimal medical therapy. Critical (> 70%) arterial stenosis was confirmed by angiogram, and angioplasty was performed with a 3.0- to 3.5-mm Stealth balloon.

RESULTS:

The average preangioplasty stenosis (North American Symptomatic Carotid Endarterectomy Trial criteria) was 72 +/- 8% (mean +/- SD), with a significant improvement seen after angioplasty; the best angiographic stenosis (after healing of intimal injury, if any) was 43 +/- 24% (P < .001). Overall PCTA was successful in 82% of the vessels. There were two strokes during angioplasty for a 30-day morbidity rate of 9.1% per treated vessel and 11.7% per case. The other 15 patients were clinically evaluated at 3 and 6 months; all cases were without further events. Restenosis was evaluated in 8 patients (12 vessels) with an angiogram at 6 months showing further improvement compared with the initial post-PCTA stenosis (51 +/- 10% versus 37 +/- 21% [P = .05]).

CONCLUSIONS:

PCTA may be a beneficial therapy in selected cases of symptomatic intracranial atherosclerotic stenosis. Further study using a randomized trial is needed.

• Authors: W M Clark, S L Barnwell, G Nesbit, O R O'Neill, M L Wynn, B M Coull
• Journal: Stroke (Stroke) Vol. 26 Issue 7 Pg. 1200-4 (Jul 1995) ISSN: 0039-2499 [Print] United States
• PMID: 7604414 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Organotechnetium Compounds
• Oximes
• Technetium Tc 99m Exametazime

Topics

• Aged
• Angioplasty, Balloon (adverse effects, instrumentation, methods)
• Arteriosclerosis (diagnostic imaging, therapy)
• Cerebral Angiography
• Cerebrovascular Disorders (etiology)
• Constriction, Pathologic (diagnostic imaging, therapy)
• Female
• Follow-Up Studies
• Humans
• Intracranial Arteriosclerosis (diagnostic imaging, therapy)
• Intraoperative Complications
• Male
• Middle Aged
• Neurologic Examination
• Organotechnetium Compounds
• Oximes
• Recurrence
• Safety
• Technetium Tc 99m Exametazime
• Tomography, Emission-Computed, Single-Photon
• Tunica Intima (pathology)