TRANSLUMINAL ANGIOPLASTY, THROMBOLYSIS, AND STENTING FOR EXTRACRANIALAND INTRACRANIAL CEREBRAL VASCULAR-DISEASE

Percutaneous transluminal angioplasty, alone or in conjunction with th rombolysis and/or stenting, is now being performed in selected cases f or hemodynamically significant stenosis (>70%), involving both extracr anial and intracranial cerebral vascular lesions. In the majority of c ases, atherosclerosis was the major cause for symptomatic narrowing, a lthough other causes included fibromuscular dysplasia, cerebral arteri tis, postsurgical intimal hyperplasia, and acute arterial dissection. In some cases, direct intraarterial thrombolysis and angioplasty succe ssfully restored perfusion to completely occluded blood vessels to the brain, and in other cases acute vessel closure or dissection of extra cranial vessels was successfully managed with stent deployment. Since 1981, 325 patients, ranging in age from 9-78 years old, have been succ essfully treated by these techniques: 143 (44%) cases involved the ant erior cerebral circulation; and 182 (56%) cases, the posterior cerebra l circulation. Complications included 17 (5.2%) strokes (of which 4 [1 .2%] died), and 23 (7.1%) cases of transient cerebral ischemia. Radiol ogical follow-up demonstrated 24 (7.4%) cases of restenosis. This stud y indicates the feasibility of angioplasty as a treatment alternative, in conjunction with thrombolysis and intravascular stenting, for extr acranial and intracranial obstructive cerebral vascular disorders and may also provide an interventional pathway in the treatment of acute s troke patients.