Medium-term results of undersized angioplasty and stenting for symptomatic high-grade intracranial atherosclerotic stenosis with Enterprise

Abstract

Purpose: The aim of this retrospective study is to evaluate medium-term results of undersized balloon angioplasty and stenting for symptomatic high-grade (70-99%) stenosis of a major intracranial artery with Enterprise stent.

Methods: This study included 68 consecutive symptomatic (recurrent transient ischemic attack (TIA) or ischemic stroke under dual antiplatelet treatment) patients with high-grade (70-99%) stenosis of a major intracranial artery who were endovascularly treated with undersized balloon angioplasty and Enterprise stent deployment between July 2012 and December 2017. Primary outcomes were any stroke or death within 30 days after procedure. Secondary outcomes were technical success rates, stroke and restenosis during the follow-up period.

Results: A total of 68 lesions in 68 patients (mean age: 62 ± 7 years) were treated with a technical success rate of 99%. The degree of pre-procedural stenosis was 92 ± 6% and dropped to 12 ± 10% after stent deployment. No patient developed any stroke or death during the periprocedural period. Intracranial hemorrhage was observed in 1 (1.5%) patient. In 60 (88%) patients with available imaging follow-up in-stent restenosis was observed in 2 patients. Mean follow-up period was 22 ± 17 months (range 6-72) and none of the patients experienced recurrent TIA or stroke during the follow-up period.

Conclusion: In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results.

Keywords: Enterprise; intracranial high-grade stenosis; stenting; transluminal angioplasty.

Figures

Figure 1.

A 54-year-old male patient with high-grade stenosis at right middle cerebral artery (MCA) and left vertebral artery was referred after a recurrent stroke. He was symptomatic (had a stroke) because of the stenosis at the M1 segment of right MCA. Digital subtraction angiography (DSA) demonstrated a severe stenosis at M1 segment of right MCA (a). Percutaneous transluminal angioplasty was performed with Gateway (b) and an Enterprise stent was deployed. DSA after percutaneous transluminal angioplasty and stenting (PTAS) revealed minimal residual stenosis (

Figure 2.

A 65-year-old male patient was referred with a recurrent stroke due to right vertebral artery stenosis and had also occlusion at right internal carotid artery and left vertebral artery (a and b). After undersized balloon angioplasty with Gateway an abnormal location of the tip of the microwire in anterior inferior cerebellar artery (AICA) was detected (c and d). An Enterprise stent was deployed and after deployment digital subtraction angiography (DSA) demonstrates near 10% residual stenosis (e). After deployment of the stent, a selective angiography of the AICA was performed due to suspicion of a microwire perforation and DSA demonstrates extravasation from a small branch of the AICA (f). Coil embolization was performed and on the completion of DSA total embolization of the extravasation and almost no residual stenosis at vertebral artery was observed (g).