Percutaneous transluminal angioplasty in the treatment of atherosclerotic disease of the anterior cerebral circulation and hemodynamic evaluation

1995 ◽  
Vol 82 (6) ◽  
pp. 953-960 ◽  
Author(s):  
Hajime Touho
Keyword(s):  
Cerebral Circulation ◽  
Percutaneous Transluminal Angioplasty ◽  
Cerebral Perfusion ◽  
Transluminal Angioplasty ◽  
Content Type ◽  
Vasodilatory Response ◽  
Percutaneous Transluminal ◽  
Stenotic Lesions ◽  
Fine Print

✓ Nineteen patients between 56 and 76 years of age with clinically symptomatic atherosclerotic stenotic lesions at or distal to the C-5 segment in the carotid arterial system underwent percutaneous transluminal angioplasty (PTA). The 19 patients had a total of 19 stenotic lesions, including two lesions in the C-5 segment, three in the C-4 segment, and three in the C-2 segment of the carotid artery, six in the M1 segment and three in the M2 segment of the middle cerebral artery, and two in the A2 segment of the anterior cerebral artery. Both prior to and more than 6 months after PTA, angiograms were performed and cerebral perfusion was measured using 99mTc-hexamethyl-propyleneamine-oxime single-photon emission computerized tomography, before and after the administration of 10 mg/kg acetazolamide. Percutaneous transluminal angioplasty could be performed in 13 (68.4%) of the 19 patients. The mean degree of stenosis (± standard deviation) was 83.1% ± 8.6% before PTA, but only 35.8% ± 17.3% on the follow-up angiograms. Restenosis was detected in follow-up angiograms in five (38.5%) of the 13 patients. Seven of the 13 patients exhibited improvement in their neurological condition after PTA and had shown subnormal cerebral perfusion and subnormal vasodilatory response to administration of acetazolamide prior to undergoing PTA. On the other hand, the remaining six patients exhibited no improvement in neurological condition after PTA, and four of these patients (66.7%) had shown normal perfusion and five (83.3%) had shown normal vasodilatory response to administration of acetazolamide prior to undergoing PTA. These findings suggest that PTA may be indicated for patients with atherosclerotic stenotic lesions in the anterior cerebral circulation who have subnormal cerebral perfusion and low vasodilatory response to administration of acetazolamide.

Endovascular therapy for stenosis of the petrous or cavernous portion of the internal carotid artery: percutaneous transluminal angioplasty compared with stent placement

2003 ◽  
Vol 98 (3) ◽  
pp. 491-497 ◽  
Author(s):  
Tomoaki Terada ◽  
Mitsuharu Tsuura ◽  
Hiroyuki Matsumoto ◽  
Osamu Masuo ◽  
Tomoyuki Tsumoto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Treated Group ◽  
Transluminal Angioplasty ◽  
Content Type ◽  
Percutaneous Transluminal ◽  
Fine Print

Object. The effects of percutaneous transluminal angioplasty (PTA) and stent placement for stenosis of the petrous or cavernous portion of the internal carotid artery (ICA) were compared. Methods. Twenty-four patients with symptomatic, greater than 60% stenosis of the petrous or cavernous portion of the ICA were treated using PTA or stent placement; 15 were treated with PTA and nine with stent insertion. Initial and follow-up results (> 3 months posttreatment) were compared in each group. Stenotic portions of the ICA were successfully opened in 13 of 15 patients in the PTA group, and in all nine patients in the stent-treated group. In one case in the PTA group stent delivery was attempted; however, the device could not pass through the vessel's tortuous curve, and PTA alone was performed in this case. Postoperatively, the mean stenotic ratio decreased from 72.1 to 29.6% in the PTA group, and from 75.6 to 2.2% in the stent-treated group. In four patients in the PTA group, stenoses greater than 50% were demonstrated on follow-up angiography performed at 3 to 6 months after PTA. In the stent-treated group, no restenosis was encountered, although in one case acute occlusion of the stent occurred; the device was recanalized with PTA and infusion of tissue plasminogen activator. This case was the only one of the 24 in which any neurological deficits related to the endovascular procedure occurred. Stent placement brought a greater gain in diameter than did PTA at the initial and late follow-up period; this gain was statistically significant. Conclusions. Stent placement is more effective than PTA for stenosis of the petrous or cavernous portion of the ICA from the viewpoint of initial and late gain in diameter.

Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis

1999 ◽  
Vol 90 (4) ◽  
pp. 688-694 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Robert A. Mericle ◽  
Demetrius K. Lopes ◽  
Ajay K. Wakhloo ◽  
Lee R. Guterman ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Carotid Artery Stenosis ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Artery Stenosis ◽  
Content Type ◽  
Percutaneous Transluminal ◽  
Fine Print

Object. Treatment consisting of percutaneous transluminal angioplasty (PTA) and stent placement has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stent placement for carotid artery restenosis.Methods. The mean interval between endarterectomy and the endovascular procedures was 57 months (range 8–220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stent placement in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event, and in one patient a pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6–57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stent placement in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty and stent placement.Conclusions. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.

Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries

1993 ◽  
Vol 78 (2) ◽  
pp. 192-198 ◽  
Author(s):  
Randall T. Higashida ◽  
Fong Y. Tsai ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Tony Smith ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Cerebral Circulation ◽  
Transluminal Angioplasty ◽  
Content Type ◽  
Atherosclerotic Stenosis ◽  
Basilar Arteries ◽  
Posterior Cerebral Circulation ◽  
Fine Print

✓ Transluminal angioplasty for hemodynamically significant stenosis (> 70%) involving the posterior cerebral circulation is now being performed by the authors in selected cases. A total of 42 lesions affecting the vertebral or basilar artery have been successfully treated by percutaneous transluminal angioplasty techniques in 41 patients. The lesions involved the proximal vertebral artery in 34 cases, the distal vertebral artery in five, and the basilar artery in three. Patients were examined clinically at 1 to 3 and 6 to 12 months after angioplasty. Three (7.1%) permanent complications occurred, consisting of stroke in two cases and vessel rupture in one. There were four (9.5%) transient complications (< 30 minutes): two cases of vessel spasm and two of cerebral ischemia. Clinical follow-up examination demonstrated improvement of symptoms in 39 cases (92.9%). Radiographic follow-up studies demonstrated three cases (7.1 %) of restenosis involving the proximal vertebral artery; two were treated by repeat angioplasty without complication, and the third is being followed clinically while the patient remains asymptomatic. In patients with significant atherosclerotic stenosis involving the vertebral or basilar artery territories, transluminal angioplasty may be of significant benefit in alleviating symptoms and improving blood flow to the posterior cerebral circulation.

Percutaneous Transluminal Angioplasty for Atherosclerotic Stenosis of the Intracranial Cerebral Arteries

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 57-62 ◽  
Author(s):  
A. Hyodo ◽  
Y. Matsumaru ◽  
I. Anno ◽  
H. Sato ◽  
N. Kato ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Cerebral Arteries ◽  
High Risk Patient ◽  
Transluminal Angioplasty ◽  
Point Of View ◽  
Stenotic Lesion ◽  
Atherosclerotic Stenosis ◽  
Percutaneous Transluminal ◽  
Stenotic Lesions

Percutaneous transluminal angioplasty (PTA) was carried out 43 times for 40 lesions in 38 cases of atheroscrelotic stenosis of the intracranial or skull base cerebral arteries. The stenotic lesions involved the middle cerebral artery in 15 cases, the basilar artery in seven cases, the internal carotid artery (petrous-supraclinoid portion) in 14 cases, and the intracranial vertebral artery in four cases. Nearly all cases were symptomatic, such as TIA or stroke, and the degree of stenosis ranged from 70 to 99 percent, with a mean of 80 percent. PTA was performed using a STEALTH balloon angioplasty catheter. In these trials, PTA was successfully performed (as indicated by a residual stenosis under 50%) 36 times. The initial success rate was 84% and stenosis was reduced from 80% to 25%. Clinical follow-up was performed from 3 to 62 months with a mean of 40 months. During this period, death due to myocardial infarction or pneumonia occurred in four cases, stroke related to previous PTA occurred in one case (due to re-stenosis) and stroke unrelated to previous PTA occurred in two cases. Angiographic follow-up was performed in 30 cases after 36 successful PTA procedures. Re-stenosis was seen in 20% of the cases, symptomatic complication occurred in 7%, and asymptomatic complications occurred in 7% of the cases. There was no mortality in this series. From analysis of complicated cases, there are several characteristic findings on the stenotic lesion. These are the stenotic lesions that located near the bifurcation, involving long segment, or showing irregular shape which is including ulcer or dissection. It is important to keep a fundamental and safe technique to reduce the complication. And besides, it is very important to keep the strict indication and to avoid the high-risk patient from a morphological point of view.

Percutaneous transluminal carotid angioplasty in fibromuscular dysplasia

1983 ◽  
Vol 59 (1) ◽  
pp. 162-165 ◽  
Author(s):  
Arthur B. Dublin ◽  
Harold A. Baltaxe ◽  
Cully A. Cobb
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
Transluminal Angioplasty ◽  
Carotid Angioplasty ◽  
Content Type ◽  
Percutaneous Transluminal ◽  
Fine Print

✓ A patient with fibromuscular dysplasia (FMD) of the internal carotid artery was treated by balloon percutaneous transluminal angioplasty (PTA). This is the sixth reported case of FMD stenotic disease which was dilated by PTA. All previous cases including the current example were treated successfully with resolution of symptoms. This procedure is associated with a relatively low morbidity and is an alternative method of treatment to operative endarterectomy for this disorder.

Percutaneous Transluminal Angioplasty for Intracranial Atherosclerotic Stenosis

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 53-56 ◽  
Author(s):  
S. Mandai ◽  
H. Matsushita ◽  
S. Akamatsu ◽  
Y. Maeda ◽  
Y. Gohda ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Transluminal Angioplasty ◽  
Atherosclerotic Stenosis ◽  
Permanent Neurological Deficit ◽  
Percutaneous Transluminal ◽  
Stenotic Lesions

Eleven patients with symptomatic intracranial atherosclerotic stenotic lesions underwent percutaneous transluminal angioplasty (PTA). Seven patients had stenosis in M1 segment of the middle cerebral artery (MCA), two in the cavernous internal carotid artery, one in M2 segment of the MCA and one in the P2 segment of the posterior cerebral artery. Initial successful dilatation (less than 50% residual stenosis) was obtained in nine patients (81.8%). Permanent neurological deficit related to PTA was seen in one patient and transient symptoms were observed in two. Re-stenosis was revealed in two cases (18.2%) in the early follow-up period. All patients with successful dilatation and without re-stenosis never had TIA or stroke after PTA. Intracranial PTA is an effective procedure, but several problems remain to be solved.

Transluminal angioplasty for treatment of intracranial arterial vasospasm

1989 ◽  
Vol 71 (5) ◽  
pp. 648-653 ◽  
Author(s):  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Leslie D. Cahan ◽  
Michael Brant-Zawadzki ◽  
Stanley Barnwell ◽  
...  
Keyword(s):  
Balloon Dilatation ◽  
Transluminal Angioplasty ◽  
Alternative Form ◽  
Luminal Diameter ◽  
Content Type ◽  
Arterial Vasospasm ◽  
Balloon Embolization ◽  
Percutaneous Transluminal ◽  
Fine Print

✓ Percutaneous transluminal angioplasty for treatment of intracerebral arterial vasospasm is now being performed in selected cases. Thirty-six vascular territories in 13 patients, ranging in age from 15 to 73 years, have been treated with a new silicone microballoon device. This balloon has allowed mechanical dilatation of segmental and diffuse areas of spastic intracerebral blood vessels less than 1 mm in diameter with return to normal luminal diameter. Follow-up angiography has documented improved cerebral perfusion without return of spasm. In 10 patients (77%), vasospasm was due to subarachnoid hemorrhage following rupture of an intracranial aneurysm. In three patients (23%), spasm with resultant neurological decline occurred during detachable balloon embolization therapy for treatment of an aneurysm. In each case, the vessel caliber returned to normal size following balloon dilatation. In nine (69%) of the 13 cases, balloon dilatation resulted in improvement of neurological function within minutes to hours following the procedure. Transluminal angioplasty techniques may offer an alternative form of therapy in the management of symptomatic arterial vasospasm.

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