Percutaneous transluminal angioplasty for intracranial arteriosclerotic lesions.

We report 17 cases of intracranial arterial stenosis treated by percutaneous transluminal angioplasty (PTA), including 9 on the intracranial internal carotid (ICA), 4 on the middle cerebral (MCA), and 4 on vertebrobasilar artery (VBA) system. All patients had ischaemic brain symptoms and stenoses of more than 60% (calculated angiographically). We treated four patients by PTA for residual stenoses after thrombolysis for acute occlusion. We used PTA balloon catheters 2.0-3.5 mm in diameter for all procedures. As a rule, the balloon was inflated for 1 min at 6 atm. All arteries were successfully dilated (stenosis less than 50%) except for one treated by PTA for residual MCA stenosis after thrombolysis. The patient died of a massive infarct due to MCA reocclusion caused by arterial dissection. Stenosis recurred in 4 of 16 patients. Repeat PTA was successfully carried out in these cases. However, stenosis recurred in one of these patients 3 months after PTA, but the patient is being followed because he is asymptomatic. PTA of intracranial arteries is effective, but its indications should be based strictly on potential risks, such as acute occlusion derived from arterial dissection.

Percutaneous transluminal angioplasty for intracranial arteriosclerotic lesions.

SUMMARY: Recent developments of the interventional neuroradiological technique made percutaneous transluminal angioplasty (PTA) possible even for intracranial arteries(1). We report our experiences of 17 cases treated by PTA including 9 intracranial internal carotid (ICA), 4 middle cerebral (MCA) and 4 vertebro-basilar arterial (VBA) stenoses and discuss the problems of the procedure. All patients had cerebral ischemic symptoms and stenoses more than 60% calculated angiographically. Three of them were treated by PTA for residual stenoses after thrombolytic therapy for acute occlusion. We used PTA balloon catheters 2.0 mm to 3.5 mm in diameter (Stealth, Target therapeutics) for all PTA procedures. A PTA balloon was inflated for 1 min at 6 atm as a rule. All were successfully dilated (stenosis less than 50%) except one treated by PTA for residual MCA stenosis after thrombolytic therapy. The patient died from massive infarction due to MCA re-occlusion caused by MCA dissection. Restenosis appeared in 4 of 16 patients. Repeated PTA was successfuly carried out for the 4 patients. However, restenosis appeared in one of them but the patient is now on follow-up because of asymptomatic course. PTA for intracranial arteries is an effective treatment but its indication should be determined strictly because of potential risk such as acute occlusion derived from dissection.

Localization of [125I]omega-conotoxin GVIA binding in human hippocampus and cerebellum.

The peptide toxin omega-conotoxin GVIA (omega-CgTx) has been shown to be a high affinity ligand for N-type calcium channels in the brain. We have employed [125I]omega-CgTx to localize N-type channels in human hippocampus and cerebellum using autoradiography. Ten micron thick slide-mounted tissue sections of human cerebellum and hippocampus were labeled with [125I]omega-CgTx under various conditions. Specific binding to human cerebellum was virtually irreversible and saturable. It was displaceable by the N-channel antagonist, omega-conotoxin MVIIA, but not by L- or P-channel ligands. Binding sites were heterogeneously distributed with denser binding in the molecular layer than the granule cell layer of cerebellum and with specific laminar patterns evident in the hippocampus. [125I]omega-CgTx should be a useful tool for the study of N-type calcium channels in human brain tissue.