A clinical study on perforator stroke resulting from Wingspan stent angioplasty for symptomatic intracranial artery stenosis / 中华放射学杂志

Objective To evaluate the incidence,potential hazards and effective countermeasure for perforator stroke (PS) resulting from stent angioplasty of symptomatic intracranial artery stenosis.Methods Peri-operation PS complications of 258 patients receiving Gateway balloon-Wingspan stenting for severe symptomatic intracranial stenosis were analyzed.The incidence,clinical course,and prognosis of PS resulting from stenting were recorded.Special attention was given to the anatomical features,clinical manifestation and video materials of patients with PS.x2 test was used for statistics.Results Two hundred and fifty-five patients received stent angioplasty successfully and 7 patients had PS ( incidence rate 2.7％ ).The patients with basilar artery stenosis had a higher incidence of PS resulting from intracranial stenting (6.1％,4/66) than patients with middle cerebral artery stenosis (2.5％,3/118) (x2 =2.320,P =0.025 ).The potential hazards for PS included preoperative perforator stroke adjacent to the stenotic segment and prominent dissection during operation.Six patients presented symptoms after awake from general anaesthesia and one had symptoms 3 hours after stenting.One deteriorated gradually and the others reached the maximum deficit almost at once.At the follow-up of 3 months,3 patients were disabled and scored one,two,two by mRS respectively.Conclusion The incidence of PS resulting from intracranial stenting was low and the prognosis was not disastrous.Stenosis at basilar artery and preoperative perforator stroke adjacent to the stenotic segment were potential risk factors for PS complication.Proper maneuver of angioplasty may decrease the incidence of PS and improve the prognosis.

Perforator stroke and stenting of intracranial arterial stenosis / 介入放射学杂志

Perforator stroke(PS)is one of peri-procedural complications associated with stenting of intracranial arterial stenosis.A lot of perforator arteries are derived from intracranial arteries with difference from coronary arteries,because once the intracranial perforator arteries of crucial regions are occluded,may lead to fatal prognosis.Three hypothesis have been used to explain PS including snow-plowing,stent jailing effect and in-stent neointimal growth.In vivo models,investigators have already found these phenomenas.After much attention been paid on PS,authors have published a report covered with a large amount of cases in 2006. The author figured out that patients with perforator infarct adjacent to the stenotie segment(PIAS)under MRI beforehand would have higher chance occurring PS after stenting of intracranial stenosis.The patients with priority of PS easily are affected by the morphology,location,etiology,sites,the type and equipments.Many yet unsolved problems including the prevention would arouse us to go deeper into for the exploration of the mechanism.(J Intervent Radiol,2007,16:858-862)