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Outcome of intracranial arterial stenting of symptomatic atherosclerotic disease: A single center experience from Saudi Arabia

Youssef Al Said, Khalil Kurdi, Saleh S. Baeesa, Ahmed Najjar, Mohammed Almekhlafi and Ahmed Hassan
Neurosciences Journal October 2016, 21 (4) 366-371; DOI: https://doi.org/10.17712/nsj.2016.4.20160199

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Case illustration of anterior circulation stenting, a 54-year-old male (patient # 20) presented with left hemiparesis due to right ICA 80% stenosis at the supraclinoid segment; arrows shows a) the segment of severe stenosis at the supraclinoid segment of the internal carotid artery, b) resolution of the stenosis after the stent placement, c-d) The patient underwent percutaneous angioplasty and stent placement with ferrous stent with good resolution of the stenotic part.

  • Figure 2
    Figure 2

    Case illustration of posterior circulation stenting, a 69-year-old male (patient # 22) presented with recurrent vertebrobasilar insufficiency due to near occlusion of mid basilar artery, a-d) He underwent percutaneous angioplasty; arrows shows the segment of near occlusion at the mid basilar artery. and e-f) Showed good patency of the basilar artery after stent placement with Taxus Liberte.

Tables

  • Table 1

    Clinical, procedural and outcome details of the studied patients.

    Age (sex) / clinical historyVessel affected (% of stenosis based on DSA)Endovascular treatment (anesthesia)Type of stent (length/mm)Outcome/complication (follow up)
    1. 67 (F) / Slurred speech and right arm weakness.Left M1-MCA (80%)Angioplasty and stenting, GATaxus (2x10 mm)Excellent (16 months)
    No new infarction or stent stenosis.
    2. 61 (M) / Lower limbs paresis with facial weakness.Mid-Basilar artery (85%)Angioplasty and stenting, GATaxus (3x12 mm)Died (6 months) from post-procedural pontine infarction.
    3. 56 (M) / Right side hemiparesis.Mid-basilar artery (80%)Angioplasty and stenting, GACardio stent (3.5x18 mm)Excellent (4 years)
    No new infarction or stent stenosis.
    4. 76 (M) / Right hemiplegia and recurrent TIA’sMid-basilar artery (60%)Angioplasty and stenting, GAEndeavor cardiac stent (2.5x8 mm)Excellent (16 months)
    No new infarction or stent stenosis.
    5. 65 (M) / Previous stroke of VBA originMid-basilar artery (60%)Angioplasty and stenting, GAFailed (tortuous VA and severe spasm)NA
    6. 45 (M) / Recurrent right hemiparesisMid-basilar artery (60%) Right petro-cavernous-ICA (80%)Angioplasty and stenting, GAWing span stents: 3.5x15 mm (for mid-basilar) 4 x 15 mm (for ICA)Died (one month)
    Post-procedural acute right Pons infarction
    7. 56 (M) / Recurrent left side TIA’sLeft supraclinoid ICA (75%).Angioplasty and stenting, LACypher Select Drug Eluting stent (2.5x13 mm)Excellent (3 years)
    No new infarction or stent stenosis.
    8. 79 (F) / Recurrent attacks of dizziness diplopia and ptosisRight vertebral basilar junction (60%)Angioplasty and Stenting, GATaxux Liberte (2.75x16 mm)Excellent (4 years)
    No new infarction or stent stenosis.
    9. 54 (M) / Recurrent attacks of incoordination and unsteady gaitLeft proximal IC vertebral artery (80%)Angioplasty and stenting, LATaxus (2.5x16 mm)Good (3 years)
    No restenosis. Left MCA infarction due to severe right ICA stenosis (90%). No intervention due to renal failure.
    10. 39 (M) / left sided weaknessRight cavernous-ICA (80%)Angioplasty and stenting, LAPrecise Nitinol stent Taxus stent (2.5x10 mm)Good (2 years)
    No new infarction or stent stenosis.
    11. 63 (M) / Recurrent dysarthria and unsteady gaitRight Vertebrobasilar junction artery (80%)Angioplasty and stenting, LATaxus (2.5x16 mm)Excellent (2 years)
    No new infarction or stent stenosis.
    12. 55 (F) / Recurrent TIAsLeft Vertebrobasilar junction artery (80%)Angioplasty and stenting, LATaxus (3 x 20 mm)Poor (12 months)
    Post-procedural right sided hemiplegia Lt pontine infarction, patent stent.
    13. 47 (M) / Recurrent right side hemiparesisProximal vertebral artery (80%)Angioplasty and stenting, GADriver RX cardiac stent 3.5x24 mmExcellent (2 years)
    No new infarction or stent stenosis.
    14. 42 (F) / Right upper limb weakness.left ophthalmic-ICA (85%)Angioplasty and stenting, GATaxus (3x20 mm)Excellent (18 months)
    No new infarction or stent stenosis.
    15. 70 (M) / Recurrent left side weaknessRight cavernous-ICA and proximal basilar artery stenosis (70% each)Angioplasty and stenting, GA For right ICADriver RX cardio stent (3.5x18 mm)Excellent (2 years)
    No new infarction or stent stenosis.
    16. 67 (M) / Recurrent TIA’sRight Vertebrobasilar junction artery (> 90%)Angioplasty and stenting, GATaxus (3.5x12 mm)Excellent (16 months)
    No new infarction or stent stenosis.
    17. 55 (F) / Right hemiparesis (on warfarin)Left M1- MCA (>80%)Angioplasty and stenting, LAFailed, (MCA spasm)Poor (1 year)
    Developed stroke on the same site.
    18. 43 (M) / Sudden LOC for 8 hrsBasilar artery (>90%)Angioplasty (+tPA) and stenting GASolitaire (2.5x16 mm)Poor (3 months)
    Died due to massive SAH.
    19. 68 (M) / Decrease LOC, walking difficulty.Right Vertebrobasilar junction (80%)Angioplasty and stenting, GAFailed due to vascular tortuosity and spasmNA
    20. 54 (M) / Left hemiparesisRight Supraclinoid ICA (80 %)Angioplasty and stenting, LAFERROUS (3x20 mm)Excellent (2 years)
    No new infarction or stent stenosis.
    21. 65 (M) / Recurrent dysarthria and mild quadriparesisDistal basilar artery (90%)Angioplasty and stenting, GAAbbott Xience Prime drug eluting (2.5x16 mm)Excellent (14 months)
    No new infarction or stent stenosis.
    22. 69 (M) / Recurrent TIA’sProximal basilar artery (90%)Angioplasty and stenting, GATaxus Liberte (3x20 mm)Excellent (1 year)
    No new infarction or stent stenosis.

    • F - Female, M - male, TIA - Transient Ischemic Attacks, MCA - middle cerebral artery, ICA - Internal Carotid Artery, GA - general anesthesia, LA - local anesthesia, NA - Not applicable, LOC - level of consciousness, tPA - tissue plasminogen activator

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