Intracranial Angioplasty and Stenting

  • Pearse Morris


The application of endovascular technology to the treatment of severe intracranial atherosclerotic occlusive disease derives from the recognition of the grave prognosis for such patients once they become symptomatic and from the lack of an established mode of effective treatment. It is thought, based on various sources, that intracranial atherosclerotic stenotic lesions carry a risk of stroke of 7% to 56% per year and a strong correlation with high risk of death from ischemic heart disease, but the studies supporting these assumptions are mostly small and retrospective or nonrandomized in methodology.1–5 The efficacy of medical treatment of such lesions with antiplatelet therapy and/or warfarin is not yet firmly established, and external carotid artery to internal carotid artery surgical bypass does not seem to be effective for most patients.6 A small, retrospective study of warfarin versus aspirin in the treatment of intracranial stenosis indicates a slightly greater efficacy from warfarin in symptomatic patients. Rates of major vascular events of 8.4% (stroke 3.6%) with warfarin and 18.1% (stroke 10.4%) per year with aspirin were seen.? Evidence supporting a slightly greater efficacy for warfarin compared with antiplatelet medication was also seen in an observational study of symptomatic intracranial atherosclerotic disease, in which a 31% and 55.8% risk of ischemic events was seen in patients taking warfarin or antiplatelet agents, respectively.5 Follow-up studies indicate that intra-cranial atherosclerotic disease once detected is also likely to have a progressive course.58 In summary, the prospective management of a patient with severe intracranial atherosclerotic disease, particularly once it becomes symptomatic, is still a dilemma.


Internal Carotid Artery Vertebral Artery Basilar Artery Posterior Inferior Cerebellar Artery Left Vertebral Artery 
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Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Pearse Morris
    • 1
  1. 1.School of MedicineWake Forest UniversityWinston-SalemUSA

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