Stenting for a symptomatic posterior cerebral artery stenosis

Endovascular Management of Cerebral Aneurysms of the Posterior Cerebral Artery

Purpose: To investigate the safety and efficacy of endovascular embolization of cerebral aneurysms at the P1–P3 segments of the posterior cerebral artery (PCA).

Materials and Methods: Seventy-seven patients with 77 PCA aneurysms who were treated with endovascular embolization were enrolled, including 35 (45.5%) patients with ruptured aneurysms and 42 (54.5%) with unruptured ones. The pretreatment clinical data and aneurysm occlusion status after treatment and at follow-up were analyzed.

Results: All patients were successfully treated endovascularly, including coiling alone in 10 (13.0%) patients, stent-assisted coiling in 18 (23.4%), parent artery occlusion in 25 (32.5%), and pipeline embolization device (PED) in 24 (31.2%). Complete occlusion was achieved in 48 (62.3%) aneurysms, residual neck in 4 (5.2%), and residual aneurysm in the other 25 (32.5%) at the end of embolization. Periprocedural complications occurred in eight patients, including acute thrombosis in seven (9.1%) and intraprocedural subarachnoid hemorrhage in one (1.3%), with the total complication rate of 10.4%. Follow-up was performed in 60 patients (77.9%) for 42 ± 11 months; the mRS score was 0–2 in 55 (91.7%) patients, three in four patients (6.7%), and six in one patient (1.7%). Fifty-three (88.3%) patients (53 aneurysms) had stable or complete occlusion, and seven (11.7%) patients had aneurysm recurrence or residual aneurysm. Among 19 patients treated with PED at follow-up, 15 aneurysms (78.9%) proceeded to complete occlusion while four (21.1%) aneurysms showed residual aneurysm.

Conclusion: Endovascular embolization remains a good choice of treatment with high safety and efficacy for posterior cerebral artery aneurysms.

Stenting and angioplasty of small cerebral arteries in symptomatic intracranial atherosclerotic disease

BACKGROUND

Intracranial atherosclerotic disease (ICAD) is a common cause of stroke with a poor natural history despite medical therapy. Few studies have investigated endovascular therapies for the treatment of symptomatic ICAD in distal intracranial arteries. Here, we present the feasibility and safety of balloon angioplasty with and without stenting in patients with medically refractory small artery symptomatic ICAD.

METHOD

Personal logs were reviewed to identify patients who were treated for small artery ICAD (stenosis > 50%) using angioplasty ± stenting. Small cerebral arteries were defined by a diameter ≤ 2 mm or any branch distal to a large intracranial vessel (i.e. distal to ICA, M1, A1, Vertebrobasilar trunk). Patient characteristics, clinical manifestations, treatment, hospital course, and follow up data was collected and analyzed.

RESULTS

Ten patients (12 arteries) were treated with either primary balloon angioplasty (58.3%) or angioplasty with stenting (41.6 %) with 100% technical success rate. Mean pre-treatment stenosis was 79.9% while mean post-treatment stenosis was 19.0%. There were no major peri-procedural complications including symptomatic intracranial hemorrhage or mortality; three cases were complicated by groin hematoma. Patients were followed for a mean total of 18.6 months with only one symptomatic restenosis which was re-treated successfully. All patients had good functional outcome with a mRS of either 0 (80%) or 1 (20%) on follow up.

CONCLUSION

In our case series, treatment of symptomatic small artery ICAD with angioplasty ± stenting was safe and effective. These interventions should be considered as an alternative treatment for ICAD patients refractory to medical therapy.

The safety and efficacy of stenting in the treatment of complex posterior cerebral artery aneurysms: a seven-case report and literature review

OBJECTIVE

To investigate the safety and efficacy of stenting with coil in the endovascular treatment of complex posterior cerebral artery (PCA) aneurysms.

METHODS

The data on PCA aneurysms treated with stents were retrospectively reviewed from a prospectively collected intervention database. The literature was reviewed concerning the use of stents for PCA aneurysms.

RESULTS

Seven cases with complex PCA aneurysms (male: female = 6:1; ruptured: unruptured = 4:3) were retrieved from our database. Three aneurysms were localized at the junction of P1 and P2 segments (P1-2), two at P1, and two at P2A. Four were wide-necked saccular aneurysms, while the other three were dissecting ones. A total of nine stents (one Neuroform and eight Enterprise stents) were successfully deployed. Two aneurysms were totally eliminated, three were with neck residues and two were partially occluded. No procedure-related complications occurred. All patients recovered well. Angiographic follow-ups (FU) showed that three aneurysms achieved total obliterations, one got improved, two remained stable, and one recurred. The recurred aneurysm caused no symptom and was treated with two stents. Clinical FU demonstrated no neurological deterioration or bleeding. In literature review, the procedure-related mortality is 5.3 % (2/38). The incidence of permanent neurologic deficit is 2.6 % (1/38). Three (3/23) aneurysms recurred, of which one caused rebleeding. Four (4/23) in-stent stenoses were all asymptomatic. No other hemorrhagic or ischemic event occurred in clinical FU.

CONCLUSION

Stent offers a therapeutic alternative for complex PCA aneurysms especially when PVO cannot be tolerated. Long-term therapeutic efficacy requires further observations in clinical series with larger case numbers.