Outcome of stent replacement for symptomatic intracranial large-vessel stenosis

Abstract

  At the present time, there is no evidence that establishes the effectiveness of endovascular treatment for intracranial vascular stenosis. Aggressive medical treatment for such stenoses does not provide satisfactory results. In clinical practice, endovascular treatment is sometimes performed for symptomatic and progressive intracranial stenotic lesions. Here, we retrospectively analyzed our hospital’s cases of stent placement for intracranial vascular stenosis (n＝26 patients; 21 males, five females, age 67.2 years [range 52‒85 years]). The lesions were at the internal carotid (IC) in six patients, M1 in 14, M2 in one, vertebral artery (VA) in four, and basilar artery (BA) in one patient. The stent placement was successful in all cases. There was only one case of asymptomatic subarachnoid hemorrhage, which occurred as a complication during the perioperative period. Restenosis occurred in two patients within 3 months, but no patients underwent additional treatment. Although the SAMMPRIS trial did not demonstrate the usefulness of endovascular treatment in similar cases, the WEAVE and WOVEN trials reported relatively favorable outcomes with strict intraoperative management and moderate vasodilation at facilities with extensive experience. The outcomes of stent placement for symptomatic intracranial vascular stenosis were favorable in the present patients. An experienced operator will use strict indications; a conservative percutaneous transluminal angioplasty (PTA) will prevent complications, and frequent imaging examinations will be important to monitor the possibility of restenosis.