J Korean Soc Radiol JKSR Journal of the Korean Society of Radiology 1738-2637 The Korean Society of Radiology 10.3348/jksr.2011.65.1.53 Interventional Radiology Original Article Intracranial Stent Implantation for Drug Resistant Atherosclerotic Stenosis: Results of 52 Cases Kim Kuk Seon MD 1 Hwang Dae Hyun MD 1 Ko Young Hwan MD 1 Kang Ik Won MD 1 Lee Eil Seong MD 1 Han You Mie MD 1 Kim In Soo MD 2 Hur Choon Woong MD 2 Min Sun Jung MD 1 Department of Radiology, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea. Department of Neurosurgery, Myungji St. Mari's Hospital, Seoul, Korea. Corresponding author: Dae Hyun Hwang, MD. Department of Radiology, Hangang Sacred Heart Hospital, 94-200 Yeongdeungpo-dong 2-ga, Yeongdeungpo-gu, Seoul 150-719, Korea. Tel. 82-2-2639-5225, Fax. 82-2-2679-0121, mddhhwang@naver.com 07 2011 31 07 2011 65 1 53 59 22 11 2010 08 05 2011 Copyright © 2011 The Korean Society of Radiology 2011 Purpose

We evaluated the usefulness of intracranial stent implantation for treatment of drug resistant atherosclerotic stenoses.

 Materials and Methods

Between March 2004 and July 2007, we tried intracranial stent implantation in 49 patients with 52 lesions (anterior circulation 48 cases, posterior circulation 4 cases) who had an ischemic stroke with more than 50% of major cerebral artery stenosis. We classified the lesions by their location and morphology, analyzed the results in terms of the success rate, complication rate, and restenosis rate during the follow-up period.

 Results

Intracranial stent implantation was performed successfully in 43 cases (82.7%). In eight of the nine cases, the stent implantation failure was due to the tortuosity of the target vessel. There was no major periprocedural complication. One patient showed cerebellar infarction after the procedure. Mean residual stenoses decreased from 70.2% to 13.0%. Four cases (9.3%) demonstrated in-stent restenoses and more than 50% during the mean and 25.3/month after the follow-up period.

 Conclusion

Success rate of intracranial stent implantation may improve on developing technique and more experience. Low rate of complication and restenosis suggest that we can consider intracranial stent implantation for treatment of drug resistant atherosclerotic stenoses.

 Stroke, Cerebral Arterial Diseases Cerebral Stenosis, Stents Intracranial Arteriosclerosis

The authors express their gratitude to Gyung Kyu Lee, M.D., Department of Radiology, Hangang Sacred Heart Hospital, Seoul, Korea, Hey Sil Jang, Department of Administration., Myungji Saint Mary's Hospital, Seoul, Korea, Shiyi Lui, M.D., Intervention treatment center, Shanghai Saint Luke's Hospital, China, Tong Lin, M.D., Department of Emergency, Shanghai Saint Luke's Hospital, China, Tongfu Yu, M.D., Department of Radiology, Jiangsu Province Hospital, Nanjing Medical University, China, for their data analysis.

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A, B. Angiography shows 66% stenosis (arrows) at M1 segment of left MCA.

C, D. After inserted stent (arrows) above the lesion, angiography shows improved blood flow.

E. Follow up after 38 months, MRA shows no significant abnormality.

Note.-MCA = middle cerebral artery, MRA = magnetic resonance angiography

 55 years old woman who presented motor weakness and sensory change.

A. Diffusion weighted and Perfusion MRI shows left frontal lobe infarct and decreased blood flow in the left ACA territory.

B. Angiography shows long segmental severe (73%) stenosis (arrow) at supraclinoid portion of left ICA.

C. After balloon angioplasty and stent (arrow) insertion, blood flow was improved.

D. Follow up after 6 months, angiography shows restenosis (arrow) in stent.

Note.-ACA = anterior cerebral artery, ICA = internal carotid artery

 Summary of 52 Cases of Intracranial Stenting

Parenthesis indicate the number of patients.

Note.-ICA = internal carotid artery, MCA = middle cerebral artery