Interventional Neuroradiology in Acute Ischemic Stroke: Extracranial and Intracranial Angioplasty and Stenting

摘要

Atherosclerotic disease as a cause for stroke represents a major source of mortality in North America and is associated with high medical and social cost. Currently there are more than 700,000 cases of new or recurrent strokes per year [ 1 ], of which 20%-30% is attributed to atherosclerosis of the carotid bifurcation and proximal internal carotid artery. Recent advances in neurointerventional catheter-based techniques and microballoon and stent design have occurred in the past decade which have enabled the treatment of complex vascular lesions, previously deemed unapproachable using catheter-based techniques [2]. The endovascular approach is providing greater therapeutic options for patients with increased surgical risk and who are symptomatic despite maximal medical therapy. Such lesions include severe atherosclerosis in patients with significant co-morbidity such as tandem intracranial stenosis, contralateral carotid occlusion and recurrent stenosis of vessels having previously undergone surgical carotid endarterectomy. Percutaneous balloon angioplasty alone or when combined with stent placement (stent-assisted angioplasty) is also providing alternatives to treatment of carotid dissection, intracranial atherosclerosis, or recalcitrant acute thrombosis refractory to intraluminal thrombolysis, wide-necked aneurysms, and intracranial vasospasm resulting from subarachnoid hemorrhage. The technique of angioplasty and stent deployment and their current role in the management of cerebrovascular ischemic disease are presented.