Intracranial Angioplasty and Stenting: Long-Term Results from a Single Center
J.C. Wojaka,b,
D.C. Dunlapc,
K.R. Hargravec,
L.A. DeAlvarec,
H.S. Culbertsond and
J.J. Connors, IIIe
a Department of Radiology, Our Lady of Lourdes Regional Medical Center, Lafayette, La
b Department of Radiology, Louisiana State University School of Medicine, New Orleans, La
c Neurology Service, Our Lady of Lourdes Regional Medical Center, Lafayette, La
d Alexandria Neurosurgical Clinic, Alexandria, La
e Department of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami Baptist Hospital, Miami, Fla
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Fig 1. A, 71-year-old woman who initially presented with a cerebellar infarct. Posteroanterior (PA) left vertebral arteriogram reveals a high-grade stenosis of the proximal basilar artery, supplied only by this vessel (arrow). This lesion is concentric and measures <10 mm in length and is typical of lesions responding well to angioplasty alone. B, Appearance immediately after angioplasty, illustrating that safe suboptimal improvement is satisfactory. There is residual stenosis but flow is improved. C, Appearance 6 months. The patient is still asymptomatic; no repeat angioplasty was performed. D, Appearance 7 years after angioplasty shows that the lesion is stable. The patient remains asymptomatic.
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Fig 2. A, 81-year-old man who presented with recurrent left carotid artery TIAs (right-sided weakness and expressive aphasia). PA left carotid arteriogram reveals a focal but eccentric stenosis at the petrocavernous junction (arrow). The lesion is short, eccentric, and along a curve in the vessel; the vessel is >3 mm in diameter and proximal and is typical of the lesions treated with stent placement. B, Appearance immediately after stent placement. Note a small dissection (arrow). C, Appearance 6 weeks later demonstrates healing of the dissection. D, Appearance 4 years after stent placement. The mild residual stenosis remains and the patient remains asymptomatic.
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Fig 3. A, 66-year-old man with recurrent episodes of dizziness, nausea, and diplopia. Lateral view of arteriogram performed with the catheter in the innominate artery. The right vertebral artery has a hairlike residual lumen beyond the posterior inferior cerebellar artery (small arrow); the basilar artery is supplied in large part from the anterior circulation via the posterior communicating artery (larger arrow). The dominant left vertebral is occluded just above the posterior inferior cerebellar artery. B, After initial angioplasty with a 1.5-mm balloon, distal perfusion is improved (long arrow indicating antegrade flow in the basilar artery), but a severely stenotic lumen persists (short arrows). C, After placement of overlapping stents in the distal vertebral artery, there is antegrade filling of both posterior cerebral arteries indicating increased perfusion. D, Initial follow-up examination at 6 weeks reveals continued patency. The patient was followed up with CT angiography, and the stents remain patent 2 and a half years later.
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Fig 4. Graphs indicate (A) time to restenosis, (B) time to stroke, and (C) time to death.
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Fig 5. Diffusion-weighted MR image demonstrating acute infarct (arrows) produced by intracranial stenosis of the left ICA.
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