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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:166-174, January 2005
© 2005 American Society of Neuroradiology

INTERVENTIONAL

Preliminary Results of Endovascular Stent-Assisted Angioplasty for Symptomatic Middle Cerebral Artery Stenosis

Tae Hong Lee^a, Dong Hyun Kim^d, Byung-Hee Lee^e, Hak Jin Kim^a, Chang Hwa Choi^b, Kyung Pil Park^c, Dae Soo Jung^c, Suk Kim^a and Tae Yong Moon^a

^a Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine
^b Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine
^c Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine
^d Department of Diagnostic Radiology, Chosun University Hospital, Chosun University School of Medicine, Kwangju
^e Department of Diagnostic Radiology, Anyang Metrohospital, Republic of Korea

Address reprint requests to Byung-Hee Lee, MD, Department of Diagnostic Radiology, Anyang Metrohospital, 324-105, Anyang 8-Dong, Manan-Gu, Kyonggi-Do, 430-720, Republic of Korea

BACKGROUND AND PURPOSE: Stent placement for intracranial atherosclerosis has become an alternative treatment technique; however, stent placement for middle cerebral artery (MCA) stenosis remains a technical and clinical challenge. Our purpose was to assess the feasibility, safety, and effectiveness of stent placement for MCA stenosis.

METHODS: Between May 1998 and August 2003, we performed stent placement for MCA stenosis (more than 50%) in 17 patients and retrospectively analyzed the technical success rate, complications, and outcomes over 10 months.

RESULTS: Stent placement was technically successful in 16 (94.1%) patients and failed in one patient (5.9%), because the stent did not reach the lesion due to carotid artery tortuousity. In 16 patients, postprocedural angiography showed restoration of the normal luminal diameter. Acute in-stent thromboses occurred in nine patients (56.3%) and was lysed with abciximab. The parent artery ruptured in two patients (12.5%): One died from massive subarachnoid hemorrhage, and the other patient received a second stent over the tear site. Stent jumping (distal migration at the time of balloon inflation) occurred in one patient (6.3%) and was solved by implanting a second stent. Periprocedural complications included subacute in-stent thrombosis (n = 1, 6.3%) and minor stroke (n = 1, 6.3%); these were relieved with heparin therapy or local thrombolysis. Fifteen patients experienced symptomatic relief or were stable at follow-up. Angiographic follow-up (n = 6) revealed no in-stent restenosis.

CONCLUSION: Stent placement for symptomatic MCA stenosis was technically feasible and effective in alleviating symptoms and improving cerebral blood flow.

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