Transluminal angioplasty, thrombolysis, and stenting for extracranial and intracranial cerebral vascular disease

Percutaneous transluminal angioplasty, alone or in conjunction with thrombolysis and/or stenting, is now being performed in selected cases for hemodynamically significant stenosis (>70%), involving both extracranial and intracranial cerebral vascular lesions. In the majority of cases, atherosclerosis was the major cause for symptomatic narrowing, although other causes included fibromuscular dysplasia, cerebral arteritis, postsurgical intimal hyperplasia, and acute arterial dissection. In some cases, direct intraarterial thrombolysis and angioplasty successfully restored perfusion to completely occluded blood vessels to the brain, and in other cases acute vessel closure or dissection of extracranial vessels was successfully managed with stent deployment. Since 1981, 325 patients, ranging in age from 9-78 years old, have been successfully treated by these techniques: 143 (44%) cases involved the anterior cerebral circulation; and 182 (56%) cases, the posterior cerebral circulation. Complications included 17 (5.2%) strokes (of which 4 [1.2%] died), and 23 (7.1%) cases of transient cerebral ischemia. Radiological follow-up demonstrated 24 (7.4%) cases of restenosis. This study indicates the feasibility of angioplasty as a treatment alternative, in conjunction with thrombolysis and intravascular stenting, for extracranial and intracranial obstructive cerebral vascular disorders and may also provide an interventional pathway in the treatment of acute stroke patients.