The Technique of Angioplasty and Stent Placement in Acute Ischemic Stroke Therapy

Abstract

Stroke is a second leading cause of death and disability in both developed and developing countries. 8-10% of ischemic strokes are caused by stenosis consequent to intracranial atherosclerotic disease. A growing body of evidence suggests that an aggressive approach may be indicated for patients with intracranial stenosis in the face of persistent symptoms despite adequate medical management, as the incidence of stroke or death in such situations is greater than 50%. By comparison, patients who fail medical management and intravenous thrombolysis, the risk of neurological complications from angioplasty, stenting, or both together, has been reported as 0% to 28%. The technical success rates for immediate, delayed and rescue angioplasty are very good (71-100%). Stenting is an option following angioplasty of a stenosed vessel and in case of embolic strokes where angioplasty alone produces only a temporary recanalizing effect. The rate of stroke and death from intracranial angioplasty and stenting is up to 10%, which is favorable when taking into consideration the risks of failed medical management. Currently, endovascular intervention is usually undertaken when medical management fails. Studies demonstrate angioplasty and stenting to be safe and effective. Technical success rate of angioplasty and stenting is up to 98-99%. In this review, we address the indications for intracranial angioplasty and stenting and provide a reasonably detailed account for readers who perform these procedures. We will also address the potential complications that might arise during intervention and provide practical tips towards successful resolution.



J Neurol Res. 2011;1(3):81-89
doi: https://doi.org/10.4021/jnr31w