Usefulness of Stent Implantation For Treatment of

Kuk Seon Kim, MD1, Dae Hyun Hwang, MD1, Young Hwan Ko, MD1, Ik Won Kang, MD1,
Eil Seong Lee, MD1, You Mie Han, MD1, Sun Jung Min, MD1, In Soo Kim, MD2,
Choon Woong Hur, MD2, Shiyi Lui, MD3, Tong Lin, MD3, Tongfu You, MD4,
Haibin Shi, MD4, Linsun Li, MD4
Oleh : Lia Angelin Adriana
Moderator : dr. Yovita Andhitara, SpS, MSi.Med
A Journal Review
Stroke is the 2nd most important cause of death and
is the leading cause of physical disability in Koreans.

6-29% of all ischemic strokes are related to stenotic
lesions located in large, intracranial vessels, and an
increased risk for stroke, heart disease, and death
has been consistently observed
Percutaneous transluminal angioplasty & stenting
have been proposed as an alternative treatment for
patients with intracranial atherosclerotic stenosis

This journal reports, the results for
angioplasty/stenting the intracranial arteries of 85
consecutive patients compared with those which
have already been reported

To evaluate the usefulness of intracranial stent
implantation for treating patients with atherosclerotic
stenosis and with recurrent, ischemic, neurological
symptoms despite having undergone medical therapy.

Between March 2004 and April 2010, we attempted
intracranial, stent-assisted angioplasty in 77 patients
with 85 lesions (anterior circulation 73 cases, posterior
circulation 12 cases) and who had ischemic
neurological symptoms with more than 50% major
cerebral artery stenosis.
We analyzed the results regarding the technical
success rate, complication rate, and restenosis rate
during the mean 29.4 month follow-up period.

Recurent symptoms caused by intracranial artery stenosis while the
patient was being treated with the optimal dose of an antiplatelet or
anticoagulation medication and angiographically proven
Significant atherosclerotic stenoses (more than 50%) that were
responsible for the patients symptoms
Age ranged from 37 to 77 years
51%
49%
Gender (n=77)
Male
Female
47%
39%
9%
5%
Location (n=85)
ICA
MCA
Basilar
artery
Vertebral
artery
43 males,
42 females
(85 intracranial arteries)
preoperative CT or MRI or
both as well as cerebral
digital subtraction
angiography.
Pre-procedural quantitative
angiographic measurements
were obtained. The degree of
stenosis was calculated
according to NASCET criteria
for grading carotid stenosis
Premedicated with aspirin 100
mg and clopidogrel 75 mg for A
minimum of three days prior the
intervention.

Intervention
Clopidogrel & aspirin
was continued for 4-12
weeks following the
treatment, and was
continued with aspirin
during the remainder of
each patients life.

Maintain ACT between
200&250 secondsgiving
additional
Boluses of heparin

Evaluation :
- Procedure success rate
- Periprocedural complication
- Symptom recurrence of
stenosis
* NASCET : North American Symptomatic Endarterectomy Trial
* ACT : Activated Clotting Time

Intracranial stent implantation was successfully performed in 74 cases (87.1%). In
nine cases among the 11, failed cases, stent implantation failure was due to the
tortuosity of the target vessel.
One patient experienced middle cerebral artery rupture during the procedure, and
we embolized the vessel using a microcoil.
9 patients were loss to follow up, and the data were excluded
During follow up period, 2 patients develop TIA symptoms and revealed newly
infarcted lesion. 2 patients developed subacute occlusion of the treated artery 3
weeks after the procedure.
One patient stop taking anticoagulant and ischemic neurological symptoms develop
two weeks after the procedure. The lesion develop hemorrhagic transformation one
week later.

One patient died 6 weeks after the procedure because a slip down resulted in
traumatic ICH
One patient had severe stenosis in the left MCA and distal M1 portion, 6 months
after the procedure, ischemic neurologic symptom recurred and angiography
showed MCA stenosis of the opponent side. After 19 months follow up there were
no restenosis.
Three patients showed restenosis of the stent-treated artery during the follow up
period
One patient who underwent balloon dilatation showed no further restenosis.
Another patient showed restenosis on the following angiogram but was without
symptoms.
Case 1
A.Angiography showed severe stenosis in the
left MCA in the distal M1 portion.

B. After stent-assisted angioplasty, the left
MCA was completely recanalized.

C, D. The patient presented with recurrent
ischemic neurologic symptoms on the
contralateral side six months after the
procedure. As her symptoms were related to
severe stenosis in the right MCA M1
segment, stent-assisted angioplasty was
performed

E, F. Follow-up angiography performed
both 13 and 19 months after the procedure,
shows good flow patency with stent
implantation in the right and left MCA,
respectively.
Characteristic Value
Technical result
Technical success rate
Technical failure rate

Stenosis
Pre-procedural stenosis
Post-procedural stenosis

Complications
MCA rupture
*Ischemic stroke
Death

Follow up results
No significant change
Re-stenosis
Follow up loss

87.1% (74/85)
12.9% (11/85)

72.3%
14.7%

1
5
3

61
4
9
TIA: Transient ischemic attack
* Including 2 transient ischemic attack
Two reperfusion injury after subacute infarction and one traumatic intracerebral hematoma
Because of continually advancing device
technology, intracranial stenting is now
feasible.
A relatively high success rate (87.1%) and
few procedure-related complications
(1.2%), Restenosis rates (4.0%) are similar
to those of previous reports
The angiographic follow up data is limited
because clinically symptom free patients
without any ischemic lesion seen on follow-
up MRI examination, didnt undergo follow-
up angiography
Five patient developed sub acute occluded
infarction or ICH as following stent-assisted
angioplasty of intracranial vessels risk for
ICH is high especially for the first hours of
treatment due to hyperperfusion of the
previously hypoperfused brain.
Angulation and tortuosity of the
blood vessel are the most important
factors in failed stent implantation
Stent rigidity and technical problems
also play an important role

Perfusion study, reverse capacity test,
evaluation of morphology and localization of
stenosis, side branches and perforators
closing the stenotic lesion should be
evaluated before stent implant.
As stent-assisted angioplasty in intracranial,
atherosclerotic stenosis is effective and relatively safe
can be considered as an alternative treatment for
patients with recurrent, ischemic, neurologic
symptoms despite having undergone medical therapy.
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Kuk Seon Kim, MD1, Dae Hyun Hwang, MD1, Young Hwan Ko, MD1, Ik Won Kang, MD1,

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