[Symptomatic intracranial artery stenosis: angiographic classifications and stent-assisted angioplasty].

OBJECTIVE

To assess the safety and efficacy of stent-assisted angioplasty (SAA) for symptomatic intracranial artery stenosis, and to evaluate preliminarily the significance of classification of location, morphology and access (LMA classification) of intracranial artery stenosis in SAA.

METHODS

Forty-two patients with symptomatic intracranial artery stenosis (diameter reduction: 50% - 74%, n = 15; >or= 75%, n = 27), located in middle cerebral artery (n = 27), intracranial internal carotid artery (n = 4), intracranial vertebral artery (n = 7) and basilar artery (n = 4) respectively, refractory to medical therapy were enrolled in this study.

RESULTS

LMA classification: 23 of the forty-two lesions (54.8%) located at the site of bifurcation, which were classified according to the location into type A (n = 8), B (n = 11), C (n = 2), D (n = 1) and F (n = 1) respectively. Type A, B and C lesions were 19, 19 and 4 respectively in the light of morphologic classification. Type I, II and III accesses were 15, 23 and 4 respectively in the light of access classification.

TECHNIQUE: The technical successful rate of SAA was 95.2% (40/42) for the group overall, and 100% (15/15), 94.7% (22/23), and 75% (3/4) for type I, II, III accesses, respectively. The rate of periprocedural complication and death was 9.5% (4/42), including acute occlusion (n = 1) and high perfusion syndrome (n = 3). After emergency measures, 3 patients were cured completely, and the remaining one with severe MCA trunk stenosis of type C lesion died of subarachnoid hemorrhage (2.4%). During a clinical follow-up period ranging from 1 to 18 months (median 8 months), 39 patients receiving SAA have been still free from ischemic events. There was no restenosisfound angiographically 6 months (n = 7) and 12 months (n = 4) after SAA.

CONCLUSIONS

Our results suggest that under rigorous control of procedural and periprocedural measures, SAA appears to be a safe and effective therapy for symptomatic intracranial stenoses of type A and B lesions, but it is not risk-free for type C lesions. The LMA classification is helpful for predicting the results of SAA and to design the procedure. However, further study is needed.