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Journal of Korean Neurosurgical Society 2011;50(4): 322-326.
doi: https://doi.org/10.3340/jkns.2011.50.4.322
Urgent Recanalization with Stenting for Severe Intracranial Atherosclerosis after Transient Ischemic Attack or Minor Stroke.
Tae Sik Park, Beom Jin Choi, Tae Hong Lee, Joon Suk Song, Dong Youl Lee, Sang Min Sung
1Department of Neurosurgery, Wallace Memorial Baptist Hospital, Busan, Korea.
2Department of Neurosurgery, Pohang Stroke and Spinal Hospital, Pohang, Korea. gamsa12@hanmail.net
3Department of Diagnostic Radiology, Pusan National University Hospital, Busan, Korea.
4Department of Neurology, Pusan National University Hospital, Busan, Korea.
5Medical Research Institute, Pusan National University Hospital, Busan, Korea.
Stenting of symptomatic intracranial stenosis has recently become an alternative treatment modality. However, urgent intracranial stenting in patients with intracranial stenosis following a transient ischemic attack (TIA) or minor stroke is open to dispute. We sought to assess the feasibility, safety, and effectiveness of urgent intracranial stenting for severe stenosis (>70%) in TIA or minor stroke patients.
Between June 2009 and October 2010, stent-assisted angioplasty by using a balloon-expandable coronary stent for intracranial severe stenosis (>70%) was performed in 7 patients after TIA and 5 patients after minor stroke (14 stenotic lesions). Technical success rates, complications, angiographic findings, and clinical outcomes were retrospectively analyzed.
Stenting was successful in all 12 patients. The mean time from symptom onset to stenting was 2.1 days (1-8 days). Post-procedural angiography showed restoration to a normal luminal diameter in all patients. In-stent thrombosis occurred in one patient (n=1, 8.3%), and was lysed with abciximab. No device-related complications, such as perforations or dissections at the target arteries or intracranial hemorrhaging, occurred in any patient. The mortality rate was 0%. No patient had an ischemic event over the mean follow-up period of 12.5 months (range, 7-21 months), and follow-up angiography (n=7) revealed no significant in-stent restenosis (>50%).
Urgent recanalization with stenting is feasible, safe, and effective in patients with TIA or acute minor stroke with intracranial stenosis of > or =70%.
Key Words: Acute ischemic stroke; Transient ischemic attack; Intracranial atherosclerosis; Intracranial stenting
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