Pathological Result of Basilar Artery Stenosis Rapidly Progressed and Ruptured with Stent-Assisted Angioplasty

Intracranial artery angioplasty utilizing coronary stent is now widely tried as an effective alternative for treating intracranial artery stenosis, and several successful result of stent-assisted angioplasty for intracranial artery were reported. Authors experienced a case of the basilar artery stenosis, in which re-stenosis progressed rapidly after simple balloon angioplasty and resulted in vessel rupture during stent-assisted angioplasty. Pathological result achieved by autopsy showed vessel wall disruption at the stent and multiple interruptions and defect of elastic laminar.

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Combined Surgery and Endovascular Stenting for Basilar Artery Stenosis Refractory to Balloon Angioplasty: Technical Case Report

Acta Neurochirurgica ◽

10.1007/s007010170082 ◽

2001 ◽

Vol 143 (5) ◽

pp. 511-516 ◽

Cited By ~ 21

Author(s):

T. Terada ◽

E. Nakai ◽

M. Tsuura ◽

K. Nakai ◽

T. Itakura

Keyword(s):

Case Report ◽

Basilar Artery ◽

Balloon Angioplasty ◽

Artery Stenosis ◽

Endovascular Stenting ◽

Combined Surgery ◽

Basilar Artery Stenosis

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Stenting for symptomatic high-grade basilar artery stenosis

Vojnosanitetski pregled ◽

10.2298/vsp0909744c ◽

2009 ◽

Vol 66 (9) ◽

pp. 744-748

Author(s):

Slobodan Culafic ◽

Novak Lakicevic ◽

Miodrag Mihajlovic ◽

Dara Stefanovic ◽

Milan Spaic

Keyword(s):

Basilar Artery ◽

Balloon Angioplasty ◽

Artery Stenosis ◽

Brain Vessels ◽

Basilar Artery Stenosis ◽

History Of ◽

Balance Disorder ◽

Stent Diameter ◽

The Brain ◽

Non Surgical Treatment

Background. Stenosis of brain vessels in 5-10% of cases causes ischemic disesase of the brain. Atherosclerosis is a cause of stenosis in 95% of cases. Patients with basilar artery stenosis and recurrent ischemic attacks are candidate for stroke in 50% of cases in the first two years. Case report. A 48-year old man presented with a 12-month history of transitory ischemic attacks, periodical loss of vision and balance disorder. Diagnostic cerebral angiography performed by MSCT revealed annular stenosis of basilar artery (85%). Digital subtraction angiography (DSA) confirmed dimensions, grade and localisation of stenosis. Endovascular stenting was performed in general anesthesia. The first step of procedure was preliminary balloon angioplasty and after that self- expandable stent (diameter of 3.0 mm, length of 12 mm) was placed. Check angiogram after stenting confirmed complete dilatation of basilar artery stenosis. Conclusion. Combination of balloon angioplasty and selfexpandable stenting made possible non-surgical treatment of simptomatic basilar artery stenosis.

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Faculty Opinions recommendation of Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718157964.793490635 ◽

2014 ◽

Author(s):

Ming Liu ◽

Bo Wu

Keyword(s):

High Risk ◽

Medical Treatment ◽

Randomised Trial ◽

Artery Stenosis ◽

Intracranial Artery ◽

High Risk Patients ◽

Intracranial Artery Stenosis ◽

Risk Patients

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Bypass Surgery for Ischemic Stroke Caused by Intracranial Artery Stenosis or Occlusion

Brain Science Advances ◽

10.26599/bsa.2018.9050003 ◽

2018 ◽

Vol 4 (1) ◽

pp. 49-60 ◽

Cited By ~ 1

Author(s):

Ismatullah Soufiany ◽

Khalil Ahmad Hijrat ◽

Spina Soufiany ◽

Lukui Chen

Keyword(s):

Ischemic Stroke ◽

Cerebral Artery ◽

Vegetative State ◽

Superficial Temporal Artery ◽

Case Series ◽

Temporal Artery ◽

Artery Stenosis ◽

Intracranial Stenosis ◽

Intracranial Artery ◽

Intracranial Artery Stenosis

Surgical revascularization may be beneficial in patients with ischemic stroke caused by intracranial stenosis or occlusion who are ineligible for thrombolysis. Objective To evaluate the outcome of superficial temporal artery to middle cerebral artery (STA-MCA) bypass in ischemic stroke caused by intracranial artery stenosis or occlusion. Methods We retrospectively studied successive case series of 19 patients who underwent surgical treatment between 2013–2017 of STA-MCA bypass. Surgical procedure was performed for the patients with acute ischemic stroke who were ineligible for thrombolysis. Results Of the 19 patients enrolled, symptom aggravation occurred during medical treatment, the patients were ineligible for thrombolysis despite being within 8 hours of symptom onset. Bypass significantly improved National Institutes of Health Stroke Scale scores, mean patient age was 78.05 years (range, 39–78 y). However, male 11 (57.95%) out of nineteen patients were presented with left-sided-lesions while female 8 (42%) had right-sided lesions with significant infarction growth by diffusion weighted imaging achieved, after surgical maneuver. No major complications occurred intraoperatively, in contrast to 2 (10.5%) minor manifestation were suffering minor complications probably they included the remote infarction (posterior cerebral artery territory). Pooled analysis with our patients showed a significant neurological improvement and a good outcome in 13 (68.4%) patients without hemorrhage or any other complication, 6 (31.6%) patients with unfavorable outcome (severe disability 2; vegetative state 4, non of them are died 0;). Conclusion STA-MCA bypass may be beneficial to patients with acute stroke or stenosis in progress who are ineligible for medical therapy. Furthermore, it appears safe when the infarction is small. These findings indicate that STA-MCA bypass could be considered as a treatment option in selected patients with ischemic stroke caused by intracranial stenosis or occlusion.

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Rare RNF213 variants and the risk of intracranial artery stenosis/occlusion disease in Chinese population: a case-control study

BMC Medical Genetics ◽

10.1186/s12881-019-0788-9 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 6

Author(s):

Xin Liao ◽

Tong Zhang ◽

Bingyang Li ◽

Shimin Hu ◽

Junyu Liu ◽

...

Keyword(s):

Chinese Population ◽

Case Control Study ◽

Case Control ◽

Artery Stenosis ◽

Intracranial Artery ◽

Intracranial Artery Stenosis ◽

Control Study

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Abstract T P101: Low Serum Eicosapentaenoic Acid- Arachidonic Acid Ratio is Associated With Intracranial Stenosis in Patients With Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.tp101 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Yuko Abe ◽

Ryoichi Otsubo ◽

Sho Murase ◽

Kenichiro Nakazawa ◽

Kazuo Kitagawa

Keyword(s):

Risk Factors ◽

Arachidonic Acid ◽

Ischemic Stroke ◽

Eicosapentaenoic Acid ◽

Acute Ischemic Stroke ◽

Artery Stenosis ◽

Intracranial Artery ◽

Stroke Subtype ◽

Fa Composition ◽

Intracranial Artery Stenosis

Purpose: A low ratio of serum eicosapentaenoic acid to arachidonic acid (EPA/AA) has been associated with atherosclerotic disease. Few studies investigate the association of serum fatty acid (FA) composition with the acute ischemic stroke so far. Our aim of this study is to evaluate the relationships between FA composition and stroke subtypes, extra-/intracranial atherosclerotic stenoses, and other cerebrovascular indicators Methods: This study included 154 consecutive patients who were admitted to our hospital because of acute ischemic stroke between April 2011 and March 2012. We examined the FA composition and classical vascular risk factors. We conducted brain MRI/MRA, carotid ultrasonogram, transthoracic echocardiogram, 24hr Holter electrocardiogram, ankle brachial index (ABI) and pulse wave velocity (PWV) in order to evaluate the severity of atherosclerotic change, stroke subtype, and cardiovascular status. Results: The mean value of EPA/AA was 0.33±0.22 in all patients with acute cerebral infarction. The 154 patients in this study (mean age 71 years) were categorized as follows; large artery atherosclerosis (LA; n=57), small artery occlusion (SA; n=48), cardiogenic embolism (CE; n=18), and others (n=31). We found intracranial artery stenosis greater than 50% in 70 patients (45%). The intracranial artery stenosis was associated with low EPA/AA ratio (P=0.013) and low EPA concentration (P=0.013). This association remained significant (P<0.05) after controlling for classical atherosclerotic risk factors. We could not find a significant correlation between FA composition and stroke subtype. However, there was a tendency for the EPA/AA ratio of LA patients to be the lowest among all subtype groups. The EPA/AA ratio was not associated with ABI, PWV, prevalence of arrhythmia, or cardiac function. Conclusions: A low EPA/AA ratio was significantly associated with intracranial stenosis in patients with acute ischemic stroke. This study shows the EPA/AA ratio might be an important marker to reflect the cerebral artery stenosis.

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Plasma Levels of Apolipoprotein E and Risk of Intracranial Artery Stenosis in Acute Ischemic Stroke Patients

Annals of Nutrition and Metabolism ◽

10.1159/000343789 ◽

2013 ◽

Vol 62 (1) ◽

pp. 26-31 ◽

Cited By ~ 6

Author(s):

Yong-Jae Kim ◽

Seung-Min Lee ◽

Hyun-Ji Cho ◽

Hyun Ju Do ◽

Chang Hyung Hong ◽

...

Keyword(s):

Ischemic Stroke ◽

Apolipoprotein E ◽

Acute Ischemic Stroke ◽

Plasma Levels ◽

Artery Stenosis ◽

Intracranial Artery ◽

Stroke Patients ◽

Intracranial Artery Stenosis

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DO STUDY RESULTS TRANSLATE INTO PRACTICE? INTRACRANIAL STENTING IN GERMANY

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317000411 ◽

2017 ◽

Vol 33 (2) ◽

pp. 222-226

Author(s):

Gerhard Schillinger ◽

Ernst-Günther Hagenmeyer ◽

Andreas Pritzkau ◽

Jörg Friedrich

Keyword(s):

Stent Implantation ◽

Claims Data ◽

Artery Stenosis ◽

Control Group ◽

Cerebrovascular Event ◽

Intracranial Artery ◽

Intracranial Stenting ◽

Intracranial Atherosclerotic Disease ◽

Study Results ◽

Intracranial Artery Stenosis

Objectives: Enrolment into the SAMMPRIS trial published in September 2011 had to be stopped due to a 2.5 higher 30-day stroke and death rate in patients with percutaneous transluminal angioplasty and stenting (PTAS) compared with the control group with only medical therapy. After these results were published, one would have expected a change toward a clearer definition of indications for intracranial stent implantation in patients with intracranial artery stenosis, using this treatment only in patients suffering from recurrent strokes despite aggressive medical management.Methods: The frequency of intracranial stenting and indication parameters in patients with intracranial artery stenosis were assessed from 2010 to 2013 using claims data for all inpatient episodes from Germany's largest provider of statutory health insurance.Results: The number of intracranial stenting procedures decreased slowly from 580 in 2010 to 375 in 2013. With a rate of 29 percent there was no change between 2010 and 2013 of patients who were admitted to hospital for stent implantation, without documentation of an acute stroke or transient ischemic attack (TIA). Before PTAS, one-third of patients were admitted twice because of a stroke or TIA over a period of 5 years, 17 percent of patients had been prescribed platelet aggregation inhibitors and at least two admissions to hospital were for an ischemic cerebrovascular event before PTAS.Conclusions: Our analysis of German claims data provides little evidence of changed indications for stenting in cases of intracranial atherosclerotic disease which one might expect to be caused by the emergence of high-level evidence.

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