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AJNR - American Journal of Neuroradiology

Published ahead of print on January 17, 2008
doi: 10.3174/ajnr.A0906

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American Journal of Neuroradiology 29:773-780, April 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Transluminal Angioplasty and Stenting for Intracranial Vertebrobasilar Occlusive Lesions in Acute Stroke Patients

K. Imai^a, T. Mori^b, H. Izumoto^b, T. Kunieda^b, N. Takabatake^b, S. Yamamoto^b and M. Watanabe^c

^a Department of Emergency Medicine, Acute Stroke Center of Kyoto First Red Cross Hospital, Kyoto, Japan
^b Department of Stroke Treatment, Shonan Kamakura General Hospital, Kanagawa, Japan
^c Department of Neurology, Kumamoto University School of Medicine, Kumamoto, Japan

Please address correspondence to Keisuke Imai, Department of Emergency Medicine, Acute Stroke Center of Kyoto First Red Cross Hospital, 15-749 Honmachi Higashiyama Kyoto, 605-0981 Japan; e-mail: keisuke{at}qb4.so-net.ne.jp

BACKGROUND AND PURPOSE: The clinical outcome is often poor in acute stroke patients with a serious neurological status due to occlusive lesions of the intracranial vertebral and/or basilar artery (IVBA). The purpose of this study was to investigate retrospectively the clinical features and outcome of acute stroke patients who underwent transluminal angioplasty and/or stenting (TAS) for occlusive lesions of the IVBA and to clarify the prerequisites for improvement of outcome.

MATERIALS AND METHODS: Of 1690 consecutive acute ischemic stroke patients admitted to our institution, TAS for occlusive lesions of the IVBA was performed within 7 days after stroke onset in 28 patients. We classified these patients into 2 groups, those with total occlusion (occlusion group) and those with a high-grade stenosis (stenosis group), and compared the preprocedural neurologic status (severe: National Institutes of Health Stroke Scale >20), the rate of technical success, major procedure-related complications, subacute occlusion of the treated vessel, and favorable clinical outcome (0-2 points on a 3-month modified Rankin Scale) between the 2 groups.

RESULTS: In the occlusion group (n = 16) and stenosis group (n = 12), a severe preprocedural neurologic status was seen in 13 and 1 patients, respectively (81% versus 8%; P = .0001); technical success was achieved in 13 and 11 patients, respectively (81% versus 92%; P value not significant [NS]); complications occurred in 6 and 0 patients, respectively (38% versus 0%; P < .05); subacute occlusion was seen in 4 and 1 patients, respectively (25% versus 8%; P = NS); and a favorable clinical outcome was obtained in 3 and 9 patients, respectively (19% versus 75%; P < .01).

CONCLUSION: The clinical outcome of patients who underwent TAS for total occlusion of the IVBA was poor. Improvement of outcome requires reduction of procedure-related complications and subacute occlusion.

This article has been cited by other articles:

				A. K. Wakhloo, M. J. Deleo III, and M. M. Brown Advances in Interventional Neuroradiology Stroke, May 1, 2009; 40(5): e305 - e312. [Abstract] [Full Text] [PDF]