Intracranial percutaneous transluminal angioplasty for arteriosclerotic stenosis

Background: Patients with intracranial arteriosclerotic disease have signif icant morbidity and mortality rates, and some are unresponsive to medical t reatment and have unacceptable surgical risks. Percutaneous transluminal an gioplasty of the intracranial vessels is a possible alternative to surgery. Objectives: To present our experience with percutaneous transluminal angiop lasty and to summarize our data. Patients and Methods: Sixteen patients underwent intracranial percutaneous transluminal angioplasty for high-grade arteriosclerotic stenosis based on strict inclusion and exclusion criteria. All patients had symptoms referabl e to the stenosis except one. Angioplasty was performed in 6 intracranial v ertebral arteries, 3 basilar arteries, 5 middle cerebral arteries, and 3 di stal internal carotid arteries. One patient had concomitant stent placement . Results: There was 1 treatment failure secondary to tortuous vascular anato my. Vessel caliber was increased to more than 80% of normal in 6 patients a nd to 50% to 70% of normal in 6 patients, with a reduction of symptoms. Thr ee intimal dissections occurred during angioplasty; one of these, in a prec avernous segment of the internal carotid artery, was stented. One patient r estenosed within 1 month of treatment. The remaining treated arteries remai ned patent during follow-up of 3 months to 2 years. Stroke as a complicatio n occurred in 2 patients, 1 mild and 1 severe. There was no mortality, Conclusions: Occlusive arteriosclerotic disease involving the intracranial cerebral vessels can be managed medically with antiplatelet and anticoagula nt drug therapy or surgically. However, in patients who are unresponsive to medical therapy or who have unacceptable surgical risks, percutaneous tran sluminal angioplasty is an attractive alternative that can be performed in selected patients with relatively low risk and good clinical outcome.