Outcome of Drug-Eluting Stenting for Intracranial Stenoses
The mean age of the cohort was 65±21 years, with 10 patients (41.7%) having an infarct confirmed on head MRI or CT scan at admission. The other patients (58.3%) presented with TIAs referable to the posterior circulation. All patients had severe stenosis (>70%) with a median baseline of 83.7% in the VAO and 77.1% in the VBA, respectively.
The stents used in this series were as follows: Taxus Express 2 paclitaxel-eluting coronary stent (Boston Scientific Corporation) in six cases (figure 1), EXCELL sirolimus-eluting coronary stent (JiWei, Shandong, China) in six cases and Firebird sirolimus-eluting coronary stent (MicroPort, Shanghai, China) in 36 cases (figure 2). The success rate for delivery of the DES was 100%. There were no periprocedural complications and no death or stroke within 30 days after the procedure. All patients had a favorable functional outcome (mRs score ≤ 2) at last follow-up.
(Enlarge Image)
Figure 1.
Digital subtraction angiograms of a 74-year-old man with severe multiple tandem left vertebral artery (VA) stenoses who presented with dizziness. (A, B) Pretreatment angiogram showing severe stenoses in the left VA. (C) Angiogram showing the first stent placed at the target lesion of the VA origin. (D, E) Angiogram showing the second stent placed at the upper part of the VA. (F) Immediate results after the procedure.
(Enlarge Image)
Figure 2.
Digital subtraction angiograms of a 73-year-old man with tandem left vertebral artery (VA) stenosis who presented with ischemia symptoms. (A) Pretreatment angiogram showing severe stenosis in the left VA origin and V4 part. (B, C) Angiograms showing the first stent placed at the target lesion site; slow inflation (10 atm in this case) of the balloon was performed. (D) After implantation of the first stent, the balloon was performed to inflate the V4 part. (E) Immediate results after the procedure.
A total of 24 patients were available for follow-up at a median time of 35±2 months. Angiographic follow-up was available in 20 patients and at least a CT angiography scan was obtained from the rest. Two patients developed in-stent restenosis (10%) in the VAO; however, these two patients did not have any posterior circulation ischemic symptoms during follow-up. Two other patients had a recurrence of their referring symptoms. One of them who had recurrent posterior circulation TIA did not have restenosis on DSA. The symptoms may have resolved after antiplatelet therapy. The other patient had unilateral stenosis of the internal carotid artery before angioplasty.
Results
The mean age of the cohort was 65±21 years, with 10 patients (41.7%) having an infarct confirmed on head MRI or CT scan at admission. The other patients (58.3%) presented with TIAs referable to the posterior circulation. All patients had severe stenosis (>70%) with a median baseline of 83.7% in the VAO and 77.1% in the VBA, respectively.
The stents used in this series were as follows: Taxus Express 2 paclitaxel-eluting coronary stent (Boston Scientific Corporation) in six cases (figure 1), EXCELL sirolimus-eluting coronary stent (JiWei, Shandong, China) in six cases and Firebird sirolimus-eluting coronary stent (MicroPort, Shanghai, China) in 36 cases (figure 2). The success rate for delivery of the DES was 100%. There were no periprocedural complications and no death or stroke within 30 days after the procedure. All patients had a favorable functional outcome (mRs score ≤ 2) at last follow-up.
(Enlarge Image)
Figure 1.
Digital subtraction angiograms of a 74-year-old man with severe multiple tandem left vertebral artery (VA) stenoses who presented with dizziness. (A, B) Pretreatment angiogram showing severe stenoses in the left VA. (C) Angiogram showing the first stent placed at the target lesion of the VA origin. (D, E) Angiogram showing the second stent placed at the upper part of the VA. (F) Immediate results after the procedure.
(Enlarge Image)
Figure 2.
Digital subtraction angiograms of a 73-year-old man with tandem left vertebral artery (VA) stenosis who presented with ischemia symptoms. (A) Pretreatment angiogram showing severe stenosis in the left VA origin and V4 part. (B, C) Angiograms showing the first stent placed at the target lesion site; slow inflation (10 atm in this case) of the balloon was performed. (D) After implantation of the first stent, the balloon was performed to inflate the V4 part. (E) Immediate results after the procedure.
A total of 24 patients were available for follow-up at a median time of 35±2 months. Angiographic follow-up was available in 20 patients and at least a CT angiography scan was obtained from the rest. Two patients developed in-stent restenosis (10%) in the VAO; however, these two patients did not have any posterior circulation ischemic symptoms during follow-up. Two other patients had a recurrence of their referring symptoms. One of them who had recurrent posterior circulation TIA did not have restenosis on DSA. The symptoms may have resolved after antiplatelet therapy. The other patient had unilateral stenosis of the internal carotid artery before angioplasty.