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From the Department of Neurology (Drs. Gupta, Marshall, Mohr, and Pile-Spellman), Doris and Stanley Tananbaum Stroke Center (Drs. Schumacher, Marshall, and Mohr), Neurological Institute, Department of Interventional Neuroradiology (Drs. Schumacher, Mangla, Meyers, Duong, and Pile-Spellman), Department of Neuroradiology (Dr. Khandji), and Department of Neurological Surgery (Drs. Meyers and Pile-Spellman), New York Presbyterian Hospital, Columbia University, New York; and Departments of Radiology and Neurosurgery (Dr. Mangla), SUNY Downstate Medical Center, Brooklyn, NY.
Address correspondence and reprint requests to Dr. H. Christian Schumacher, Doris and Stanley Tananbaum Stroke Center, Neurological Institute, New York-Presbyterian Hospital, Columbia-Presbyterian Medical Center, 710 West 168th Street, Box 131, New York, NY 10032; e-mail: hs775{at}columbia.edu
Background: Endovascular revascularization for intracranial atherosclerotic stenoses is being increasingly performed at major medical centers and has been reported to be technically feasible and safe. The authors report their experience with patients who underwent such a procedure for impending stroke and neurologic instability.
Method: All 18 patients (21 intracranial lesions) treated between 1997 and 2002 at the authors’ institution with endovascular revascularization were retrospectively reviewed. Each patient had failed maximal medical therapy and was thought to be at high risk for an imminent stroke.
Results: Endovascular revascularization was performed on eight distal internal carotid artery lesions, six middle cerebral artery lesions, four intracranial vertebral artery lesions, and three basilar artery lesions. Recanalization was complete in 5 arteries (Thrombolysis in Myocardial Infarction [TIMI] Grade III), partial in 14 arteries (TIMI Grade II), and complete occlusion (TIMI 0) developed in 1 artery. In a patient with a tight basilar stenosis, no angioplasty could be performed because of the inability to cross the stenosis with the guidewire. Major periprocedural complications occurred in 9 (50%) patients: intracranial hemorrhage in 3 (17%), disabling ischemic stroke in 2 (11%), and major extracranial hemorrhage in 4 (22%). Three patients died: one from intracerebral hemorrhage and two from cardiorespiratory failure.
Conclusions: Endovascular revascularization of intracranial vessels is technically feasible and may be performed successfully. However, periprocedural complication and fatality rates in neurologically unstable patients are high. The results suggest that patient selection, procedure timing, and periprocedural medical management are critical factors to reduce periprocedural morbidity and mortality.
Received May 19, 2003. Accepted in final form October 15, 2003.
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