Preliminary results of endovascular stent-assisted angioplasty for symptomatic middle cerebral artery stenosis

AJNR Am J Neuroradiol. 2005 Jan;26(1):166-74.

Abstract

Background and purpose: Stent placement for intracranial atherosclerosis has become an alternative treatment technique; however, stent placement for middle cerebral artery (MCA) stenosis remains a technical and clinical challenge. Our purpose was to assess the feasibility, safety, and effectiveness of stent placement for MCA stenosis.

Methods: Between May 1998 and August 2003, we performed stent placement for MCA stenosis (more than 50%) in 17 patients and retrospectively analyzed the technical success rate, complications, and outcomes over 10 months.

Results: Stent placement was technically successful in 16 (94.1%) patients and failed in one patient (5.9%), because the stent did not reach the lesion due to carotid artery tortuousity. In 16 patients, postprocedural angiography showed restoration of the normal luminal diameter. Acute in-stent thromboses occurred in nine patients (56.3%) and was lysed with abciximab. The parent artery ruptured in two patients (12.5%): One died from massive subarachnoid hemorrhage, and the other patient received a second stent over the tear site. Stent jumping (distal migration at the time of balloon inflation) occurred in one patient (6.3%) and was solved by implanting a second stent. Periprocedural complications included subacute in-stent thrombosis (n = 1, 6.3%) and minor stroke (n=1, 6.3%); these were relieved with heparin therapy or local thrombolysis. Fifteen patients experienced symptomatic relief or were stable at follow-up. Angiographic follow-up (n=6) revealed no in-stent restenosis.

Conclusion: Stent placement for symptomatic MCA stenosis was technically feasible and effective in alleviating symptoms and improving cerebral blood flow.

MeSH terms

  • Adult
  • Aged
  • Angioplasty, Balloon*
  • Arterial Occlusive Diseases / diagnostic imaging
  • Arterial Occlusive Diseases / therapy*
  • Cerebral Angiography*
  • Equipment Failure
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Infarction, Middle Cerebral Artery / diagnostic imaging
  • Infarction, Middle Cerebral Artery / therapy
  • Intracranial Arteriosclerosis / diagnostic imaging
  • Intracranial Arteriosclerosis / therapy*
  • Intracranial Thrombosis / diagnostic imaging
  • Intracranial Thrombosis / therapy
  • Male
  • Middle Aged
  • Middle Cerebral Artery* / diagnostic imaging
  • Middle Cerebral Artery* / injuries
  • Retreatment
  • Retrospective Studies
  • Stents*