Skip to main content
SpringerLink
Log in

Stent Angioplasty for Treatment of Intracranial Cerebrovascular Disease

  • Chapter
Minimally Invasive Neurosurgery

  • 1005 Accesses

Abstract

Advances in the design and manufacturing of balloon and stent catheters made in the last decade have improved the operator’s ability to negotiate the tortuous anatomy of the high cervical and intracranial carotid and vertebral arteries (1–3). These technical developments have led to the endovascular treatment of cerebrovascular pathologies previously considered unapproachable from a percutaneous approach. The ability to reach and treat intracranial stenotic lesions using miniature balloon-mounted microstents has provided a promising form of therapy for well-selected patients who have failed medical therapy and for those who are not candidates for surgical bypass grafting (4,5). Similarly, the availability of improved low-profile microstents has expanded the spectrum of intracranial aneurysms that are amenable to endovascular therapy to include the wide-necked and fusiform morphology (6,7).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Lanzino G, et al. Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 1999;91:538–546.

    PubMed  CAS  Google Scholar 

  2. Higashida RT, et al. Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 1997;87:944–949.

    PubMed  CAS  Google Scholar 

  3. Phatouros CC, et al. Endovascular stenting of an acutely thrombosed basilar artery: technical case report and review of the literature. Neurosurgery 1999;44:667–673.

    Article  PubMed  CAS  Google Scholar 

  4. Gupta R, et al. Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis. Neurology 2003;61:1729–1735.

    PubMed  CAS  Google Scholar 

  5. Levy EI, et al. Transluminal stent-assisted angioplasty of the intracranial vertebrobasilar system for medically refractory, posterior circulation ischemia: early results. Neurosurgery 2001;48:1215–1221; discussion 1221–1223.

    Article  PubMed  CAS  Google Scholar 

  6. Fiorella D, et al. Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery 2004;54:6–16; discussion 16–17.

    Article  PubMed  Google Scholar 

  7. Lylyk P, et al. Endovascular reconstruction of intracranial arteries by stent placement and combined techniques. J Neurosurg 2002;97:1306–1313.

    PubMed  Google Scholar 

  8. Sacco RL, et al. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995;26:14–20.

    PubMed  CAS  Google Scholar 

  9. Prognosis of patients with symptomatic vertebral or basilar artery stenosis. The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Study Group. Stroke 1998;29:1389–1392.

    Google Scholar 

  10. Bogousslavsky J, et al. Atherosclerotic disease of the middle cerebral artery. Stroke 1986;17:1112–1120.

    PubMed  CAS  Google Scholar 

  11. The International Cooperative Study of Extracranial/Intracranial Arterial Anastomosis (EC/IC Bypass Study): methodology and entry characteristics. The EC/IC Bypass Study Group. Stroke 1985;16:397–406.

    Google Scholar 

  12. Ausman JI, Diaz FG. Critique of the extracranial-intracranial bypass study. Surg Neurol 1986;26:218–221.

    Article  PubMed  CAS  Google Scholar 

  13. Bogousslavsky J, et al. Bilateral occlusion of the trunk of the middle cerebral artery. Results of an international randomized trial. The EC/IC Bypass Study Group. Stroke 1986;17:1107–1111.

    PubMed  CAS  Google Scholar 

  14. Awad IA, Spetzler RF. Extracranial-intracranial bypass surgery: a critical analysis in light of the International Cooperative Study. Neurosurgery 1986;19:655–664.

    Article  PubMed  CAS  Google Scholar 

  15. Akins PT, et al. Natural history of stenosis from intracranial atherosclerosis by serial angiography. Stroke 1998;29:433–438.

    PubMed  CAS  Google Scholar 

  16. Caplan L, et al. Occlusive disease of the middle cerebral artery. Neurology 1985;35:975–982.

    PubMed  CAS  Google Scholar 

  17. Craig DR, et al. Intracranial internal carotid artery stenosis. Stroke 1982;13:825–828.

    PubMed  CAS  Google Scholar 

  18. Kubik C, Adams R. Occlusion of the basilar artery: a clinical and pathological study. Brain 1946;59:73–121.

    Article  Google Scholar 

  19. Archer CR, Horenstein S. Basilar artery occlusion: clinical and radiological correlation. Stroke 1977;8:383–390.

    PubMed  CAS  Google Scholar 

  20. Bruckmann H, et al. Acute vertebral-basilar thrombosis. Angiologic-clinical comparison and therapeutic implications. Acta Radiol Suppl 1986;369:38–42.

    PubMed  CAS  Google Scholar 

  21. Hacke W, et al. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 1988;19:1216–1222.

    PubMed  CAS  Google Scholar 

  22. Caplan LR, Vertebrobasilar embolism. Clin Exp Neurol 1991;28:1–22.

    PubMed  CAS  Google Scholar 

  23. Benesch CG, Chimowitz MI. Best treatment for intracranial arterial stenosis? 50 years of uncertainty. The WASID Investigators. Neurology 2000;55:465–466.

    PubMed  CAS  Google Scholar 

  24. Clark WM, et al. Safety and efficacy of percutaneous transluminal angioplasty for intracranial atherosclerotic stenosis. Stroke 1995;26:1200–1204.

    PubMed  CAS  Google Scholar 

  25. Terada T, et al. Transluminal angioplasty for arteriosclerotic disease of the distal vertebral and basilar arteries. J Neurol Neurosurg Psychiatry 1996;60:377–381.

    PubMed  CAS  Google Scholar 

  26. Gress DR, et al. Angioplasty for intracranial symptomatic vertebrobasilar ischemia. Neurosurgery 2002;51:23–27; discussion 27–29.

    Article  PubMed  Google Scholar 

  27. Marks MP, et al. Outcome of angioplasty for atherosclerotic intracranial stenosis. Stroke 1999;30:1065–1069.

    PubMed  CAS  Google Scholar 

  28. Connors JJ 3rd, Wojak JC. Percutaneous transluminal angioplasty for intracranial atherosclerotic lesions: evolution of technique and short-term results. J Neurosurg 1999;91:415–423.

    PubMed  Google Scholar 

  29. Mori T, et al. Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty. AJNR Am J Neuroradiol 1998;19:1525–1533.

    PubMed  CAS  Google Scholar 

  30. Nahser HC, et al. Intracranial vertebrobasilar stenosis: angioplasty and follow-up. AJNR Am J Neuroradiol 2000;21:1293–1301.

    PubMed  CAS  Google Scholar 

  31. Lanzino G, et al. Angioplasty and stenting of basilar artery stenosis: technical case report. Neurosurgery 1999;45:404–407; discussion 407–408.

    Article  PubMed  CAS  Google Scholar 

  32. Malek AM, et al. Tandem intracranial stent deployment for treatment of an iatrogenic, flow-limiting, basilar artery dissection: technical case report. Neurosurgery 1999;45:919–924.

    Article  PubMed  CAS  Google Scholar 

  33. Lutsep HL, et al. Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): Study Results. Stroke 2003;34:253, abstract.

    Google Scholar 

  34. Gomez CR, et al. Elective stenting of symptomatic middle cerebral artery stenosis. AJNR Am J Neuroradiol 2000;21:971–973.

    PubMed  CAS  Google Scholar 

  35. Fessler RD, et al. Improved cerebral perfusion after stenting of a petrous carotid stenosis: technical case report. Neurosurgery 1999;45:638–642.

    Article  PubMed  CAS  Google Scholar 

  36. Horowitz MB, et al. Percutaneous transluminal angioplasty and stenting of mid-basilar stenoses: three technical case reports and literature review. Neurosurgery 1999;45:925–930; discussion 930–931.

    Article  PubMed  CAS  Google Scholar 

  37. Morris PP, et al. Intracranial deployment of coronary stents for symptomatic atherosclerotic disease. AJNR Am J Neuroradiol 1999;20:1688–1694.

    PubMed  CAS  Google Scholar 

  38. Phatouros CC, et al. Primary stenting for high-grade basilar artery stenosis. AJNR Am J Neuroradiol 2000;21:1744–1749.

    PubMed  CAS  Google Scholar 

  39. Gahn G, et al. Cerebrovascular reserve before and after vertebral artery angioplasty. AJNR Am J Neuroradiol 1999;20:785–786.

    PubMed  CAS  Google Scholar 

  40. Mori T, et al. Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease. AJNR Am J Neuroradiol 2000;21:249–254.

    PubMed  CAS  Google Scholar 

  41. Eckard DA, et al. Stiff guide technique: technical report and illustrative case. AJNR Am J Neuroradiol 2003;24:275–278.

    PubMed  Google Scholar 

  42. Fessler RD, et al. Transradial approach for vertebral artery stenting: technical case report. Neurosurgery 2000;46:1524–1527; discussion 1527–1528.

    Article  PubMed  CAS  Google Scholar 

  43. Blanc R, et al. Hemostatic closure device after carotid puncture for stent and coil placement in an intracranial aneurysm: technical note. AJNR Am J Neuroradiol 2002;23:978–981.

    PubMed  Google Scholar 

  44. Mori T, Kazita K, Mori K. Cerebral angioplasty and stenting for intracranial vertebral atherosclerotic stenosis. AJNR Am J Neuroradiol 1999;20:787–789.

    PubMed  CAS  Google Scholar 

  45. Ramee SR, et al. Provisional stenting for symptomatic intracranial stenosis using a multidisciplinary approach: acute results, unexpected benefit, and one-year outcome. Catheter Cardiovasc Interv 2001;52:457–467.

    Article  PubMed  CAS  Google Scholar 

  46. Al-Mubarak N, et al. Stenting of symptomatic stenosis of the intracranial internal carotid artery. AJNR Am J Neuroradiol 1998;19:1949–951.

    PubMed  CAS  Google Scholar 

  47. Dorros G, Cohn JM, Palmer LE. Stent deployment resolves a petrous carotid artery angioplasty dissection. AJNR Am J Neuroradiol 1998;19:392–394.

    PubMed  CAS  Google Scholar 

  48. Malek AM, et al. Intracranial stent angioplasty for the treatment of symptomatic intracranial atherosclerotic disease. CV Joint Section AANS/CNS/ASITN 2001, abstract.

    Google Scholar 

  49. Rasmussen PA, et al. Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: an initial experience. J Neurosurg 2000;92:771–778.

    Article  PubMed  CAS  Google Scholar 

  50. Lylyk P, et al. Angioplasty and stent placement in intracranial atherosclerotic stenoses and dissections. AJNR Am J Neuroradiol 2002;23:430–436.

    PubMed  Google Scholar 

  51. Terada T, et al. Endovascular therapy for stenosis of the petrous or cavernous portion of the internal carotid artery: percutaneous transluminal angioplasty compared with stent placement. J Neurosurg 2003;98:491–497.

    PubMed  Google Scholar 

  52. Chimowitz MI. Angioplasty or stenting is not appropriate as first-line treatment of intracranial stenosis. Arch Neurol 2001;58:1690–1692.

    Article  PubMed  CAS  Google Scholar 

  53. Gomez CR, Orr SC. Angioplasty and stenting for primary treatment of intracranial arterial stenoses. Arch Neurol 2001;58:1687–1690.

    Article  PubMed  CAS  Google Scholar 

  54. Chaturvedi, S. and L.R. Caplan, Angioplasty for intracranial atherosclerosis: is the treatment worse than the disease? Neurology 2003;61:1647–1648.

    PubMed  Google Scholar 

  55. Moret J, et al. (Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases). J Neuroradiol 1997;24:30–44.

    PubMed  CAS  Google Scholar 

  56. Lieber BB, Stancampiano AP, Wakhloo AK. Alteration of hemodynamics in aneurysm models by stenting: influence of stent porosity. Ann Biomed Eng 1997;25:460–469.

    Article  PubMed  CAS  Google Scholar 

  57. Vanninen R, Manninen H. Ronkainen A. Broad-based intracranial aneurysms: thrombosis induced by stent placement. AJNR Am J Neuroradiol 2003;24:263–266.

    PubMed  Google Scholar 

  58. Benndorf G, et al. Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. AJNR Am J Neuroradiol 2001;22:1844–1848.

    PubMed  CAS  Google Scholar 

  59. MacKay CI, et al. Recurrence of a vertebral artery dissecting pseudoaneurysm after successful stent-supported coil embolization: case report. Neurosurgery 2003;53:754–759; discussion 760–761.

    Article  PubMed  Google Scholar 

  60. Broadbent LP, et al. Management of neuroform stent dislodgement and misplacement. AJNR Am J Neuroradiol 2003;24:1819–1822.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cerebrovascular and Endovascular Program, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

    Adel M. Malek MD, PhD

  2. Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

    Clemens M. Schirmer MD

Authors
  1. Adel M. Malek MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clemens M. Schirmer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, The Children’s Hospital, Harvard Medical School, Boston, MA

    Mark R. Proctor MD  & Peter M. Black MD, PhD  & 

  2. Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

    Peter M. Black MD, PhD

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Malek, A.M., Schirmer, C.M. (2005). Stent Angioplasty for Treatment of Intracranial Cerebrovascular Disease. In: Proctor, M.R., Black, P.M. (eds) Minimally Invasive Neurosurgery. Humana Press. https://doi.org/10.1385/1-59259-899-4:175

Download citation

  • DOI: https://doi.org/10.1385/1-59259-899-4:175

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-147-9

  • Online ISBN: 978-1-59259-899-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation