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AJNR - American Journal of Neuroradiology

Publication Preview: Published January 17, 2008

American Journal of Neuroradiology 2008;29:773.

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A0906

INTERVENTIONAL

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

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

From the Department of Emergency Medicine (K.I.), Acute Stroke Center of Kyoto First Red Cross Hospital, Kyoto, Japan; Department of Stroke Treatment (T.M., H.I., T.K., N.T., S.Y.), Shonan Kamakura General Hospital, Kanagawa, Japan; and Department of Neurology (M.W.), 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.

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				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]