Stent-Assisted Angioplasty for Symptomatic Middle Cerebral Artery Stenosis: Short-term Arteriographic and Clinical Outcome.

Ji, Kyu Yeul; Ahn, Jung Yong; Chung, Young Sun; Kim, Ok Joon; Choi, Sung Wook; Lee, Byung Hee

Original Article

Journal of Korean Neurosurgical Society 2003;34(2): 96-103.

Kyu Yeul Ji, Jung Yong Ahn, Young Sun Chung, Ok Joon Kim, Sung Wook Choi, Byung Hee Lee

¹Department of Neurosurgery, Pundang CHA Hospital, Pochon CHA Medical University, Seongnam, Korea. jyahn@cha.ac.kr
²Department of Neurology, Pundang CHA Hospital, Pochon CHA Medical University, Seongnam, Korea.
³Department of Emergency Medicine, Pundang CHA Hospital, Pochon CHA Medical University, Seongnam, Korea.
⁴Department of Radiology, Metro Hospital, Anyang, Korea.

ABSTRACT

OBJECTIVE
Stent-assisted angioplasty is an effective treatment modality in the coronary and peripheral arterial disease, however, its efficacy for intracranial atherosclerotic disease has not been verified. We assess the treatment outcome of stent-assisted angioplasty for symptomatic middle cerebral artery (MCA) stenosis. METHODS: We performed stent-assisted angioplasty in 12 patients with symptomatic high-grade stenosis(>60%) on the proximal portion of the MCA, who had either recurrent transient ischemic attacks (TIAs) resistant to medical therapy or perfusion problems. Patient records were analyzed for angiographic characteristic, degree of stenosis, preprocedural regimen of antiplatelet and/or anticoagulation agents, used devices, procedure-related complications, and clinical and radiographic outcomes.
RESULTS
Stent-assisted angioplasty was successfully performed in 8 patients without any serious complications. Two patients had arterial rupture. One of two patients was rescued by an additional stenting and balloon tamponade, and the other patient was dead. Another complications among the 2 patients included thrombotic occlusion and distal thrombosis. Residual stenosis was less than 50% in diameter in all the patients. During follow-up period (mean, 11 months), stroke attacks including TIAs did not recur in 9 of 11 patients who had experienced intractable TIAs or strokes. All of 8 patients who underwent follow-up cerebral angiography had no restenosis.
CONCLUSION
Stent-assisted angioplasty for refractory and symptomatic MCA stenosis is a relatively safe and effective procedure. It can be used to prevent recurrent TIAs or strokes in selected patients.

Key Words: Angioplasty; Arterial stenosis; Endovascular therapy; Intracranial stent; Middle cerebral artery