Effectiveness of intracranial percutaneous trans-luminal angioplasty (PTA) or stenting for atherosclerotic vertebro-basilar artery occlusion in acute phase of ischemic stroke

Abstract Objective Although short-term clinical outcomes after basilar artery stent placement have been reported previously, effectiveness of intracranial stenting for vertebro-basilar artery occlusion in acute phase of ischemic stroke is unclear. Methods We clinically investigated 8 patients with i...

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Veröffentlicht in:World neurosurgery 2016
Hauptverfasser: Wajima, Daisuke, Aketa, Shuta, Nakagawa, Ichiro, Masui, Katsuya, Yonezawa, Taiji, Enami, Tomomi, Nishida, Fukuko, Nakase, Hiroyuki
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container_title World neurosurgery
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creator Wajima, Daisuke
Aketa, Shuta
Nakagawa, Ichiro
Masui, Katsuya
Yonezawa, Taiji
Enami, Tomomi
Nishida, Fukuko
Nakase, Hiroyuki
description Abstract Objective Although short-term clinical outcomes after basilar artery stent placement have been reported previously, effectiveness of intracranial stenting for vertebro-basilar artery occlusion in acute phase of ischemic stroke is unclear. Methods We clinically investigated 8 patients with intracranial percutaneous trans-luminal angioplasty (PTA) or stenting as our protocol for symptomatic atherosclerotic vertebra-basilar artery occlusion (age range 54–80, mean 69±11 years; 6 male and 2 female) who were admitted to our hospital between August 2013 and December 2015. Results Two patients underwent PTA of the vertebra-basilar artery 2–5 months before stent placement. Other 6 patients underwent intracranial stenting just after PTA. Within the first 30 days after vertebro-basilar artery stent placement, 2 ischemic stroke complications affected patients. Ischemic complications were significantly associated with pre-stent lesion lumen over 0.5 mm. The modified Rankin Score and clinical outcome were significantly associated with complications. Clinical outcomes correlate with ischemic complications and vertebro-basilar anatomy. Conclusions Stent angioplasty may be a reasonably good treatment option for patients with technically favorable lesions, especially in vertebra-basilar atherosclerotic occlusion with medically or PTA only refractory symptoms. Despite a significant complication rate, most of our patients experienced good to excellent clinical outcomes and were free of vertebra-basilar ischemia at late midterm follow-up.
doi_str_mv 10.1016/j.wneu.2016.09.106
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Methods We clinically investigated 8 patients with intracranial percutaneous trans-luminal angioplasty (PTA) or stenting as our protocol for symptomatic atherosclerotic vertebra-basilar artery occlusion (age range 54–80, mean 69±11 years; 6 male and 2 female) who were admitted to our hospital between August 2013 and December 2015. Results Two patients underwent PTA of the vertebra-basilar artery 2–5 months before stent placement. Other 6 patients underwent intracranial stenting just after PTA. Within the first 30 days after vertebro-basilar artery stent placement, 2 ischemic stroke complications affected patients. Ischemic complications were significantly associated with pre-stent lesion lumen over 0.5 mm. The modified Rankin Score and clinical outcome were significantly associated with complications. Clinical outcomes correlate with ischemic complications and vertebro-basilar anatomy. Conclusions Stent angioplasty may be a reasonably good treatment option for patients with technically favorable lesions, especially in vertebra-basilar atherosclerotic occlusion with medically or PTA only refractory symptoms. Despite a significant complication rate, most of our patients experienced good to excellent clinical outcomes and were free of vertebra-basilar ischemia at late midterm follow-up.</description><identifier>ISSN: 1878-8750</identifier><identifier>DOI: 10.1016/j.wneu.2016.09.106</identifier><language>eng</language><subject>Neurosurgery</subject><ispartof>World neurosurgery, 2016</ispartof><rights>Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4024,27923,27924,27925</link.rule.ids></links><search><creatorcontrib>Wajima, Daisuke</creatorcontrib><creatorcontrib>Aketa, Shuta</creatorcontrib><creatorcontrib>Nakagawa, Ichiro</creatorcontrib><creatorcontrib>Masui, Katsuya</creatorcontrib><creatorcontrib>Yonezawa, Taiji</creatorcontrib><creatorcontrib>Enami, Tomomi</creatorcontrib><creatorcontrib>Nishida, Fukuko</creatorcontrib><creatorcontrib>Nakase, Hiroyuki</creatorcontrib><title>Effectiveness of intracranial percutaneous trans-luminal angioplasty (PTA) or stenting for atherosclerotic vertebro-basilar artery occlusion in acute phase of ischemic stroke</title><title>World neurosurgery</title><description>Abstract Objective Although short-term clinical outcomes after basilar artery stent placement have been reported previously, effectiveness of intracranial stenting for vertebro-basilar artery occlusion in acute phase of ischemic stroke is unclear. Methods We clinically investigated 8 patients with intracranial percutaneous trans-luminal angioplasty (PTA) or stenting as our protocol for symptomatic atherosclerotic vertebra-basilar artery occlusion (age range 54–80, mean 69±11 years; 6 male and 2 female) who were admitted to our hospital between August 2013 and December 2015. Results Two patients underwent PTA of the vertebra-basilar artery 2–5 months before stent placement. Other 6 patients underwent intracranial stenting just after PTA. Within the first 30 days after vertebro-basilar artery stent placement, 2 ischemic stroke complications affected patients. Ischemic complications were significantly associated with pre-stent lesion lumen over 0.5 mm. The modified Rankin Score and clinical outcome were significantly associated with complications. Clinical outcomes correlate with ischemic complications and vertebro-basilar anatomy. Conclusions Stent angioplasty may be a reasonably good treatment option for patients with technically favorable lesions, especially in vertebra-basilar atherosclerotic occlusion with medically or PTA only refractory symptoms. 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Methods We clinically investigated 8 patients with intracranial percutaneous trans-luminal angioplasty (PTA) or stenting as our protocol for symptomatic atherosclerotic vertebra-basilar artery occlusion (age range 54–80, mean 69±11 years; 6 male and 2 female) who were admitted to our hospital between August 2013 and December 2015. Results Two patients underwent PTA of the vertebra-basilar artery 2–5 months before stent placement. Other 6 patients underwent intracranial stenting just after PTA. Within the first 30 days after vertebro-basilar artery stent placement, 2 ischemic stroke complications affected patients. Ischemic complications were significantly associated with pre-stent lesion lumen over 0.5 mm. The modified Rankin Score and clinical outcome were significantly associated with complications. Clinical outcomes correlate with ischemic complications and vertebro-basilar anatomy. Conclusions Stent angioplasty may be a reasonably good treatment option for patients with technically favorable lesions, especially in vertebra-basilar atherosclerotic occlusion with medically or PTA only refractory symptoms. Despite a significant complication rate, most of our patients experienced good to excellent clinical outcomes and were free of vertebra-basilar ischemia at late midterm follow-up.</abstract><doi>10.1016/j.wneu.2016.09.106</doi></addata></record>
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title Effectiveness of intracranial percutaneous trans-luminal angioplasty (PTA) or stenting for atherosclerotic vertebro-basilar artery occlusion in acute phase of ischemic stroke
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