Endovascular treatment of symptomatic intracranial atheromatous stenosis: a single center study of 21 consecutive cases.

OBJECTIVES: This retrospective single-center study evaluated the technical success as well as the periprocedural and long-term complications of angioplasty with stenting of symptomatic intracranial atheromatous stenosis. PATIENTS AND METHODS: From January 2005 to December 2010, 21 patients were treated by angioplasty with stent implantation for symptomatic atheromatous intracranial stenosis greater or equal to 50% at least 7 days after a stroke. RESULTS: The median population age was 65 years (range: 41-88 years), and 76% (16/21) of the candidates had a history of transient ischemic attack (TIA) or stroke before the event qualifying them for an endovascular procedure. In addition, 86% (18/21) were taking antithrombotic medication at the time of the qualifying event. Technical success was obtained in all cases. The periprocedural stroke or death rate was 9.5% (2/21), and there was no other stroke or death after 30 days during the mean follow-up of 1.4 years. CONCLUSION: Endovascular treatment of symptomatic intracranial atherothrombotic stenosis can lead to severe complications, particularly during the periprocedural period, but it also represents the only alternative treatment for patients who fail with medical therapy. Future studies need to focus on improvement of periprocedural complications. Essentially, this should include more rigorous selection of candidates as well as a better understanding of the pathophysiological mechanism(s) of the ischemic phenomenon related to stenosis.

[Superior ophthalmic vein catheterization: treatment of a dural fistula]. / Cathétérisme de la veine ophtalmique supérieure: traitement d'une fistule durale.

We report the case of a 68-year-old woman with a chronic unilateral red eye for 3 months. The ophthalmologic exam showed engorged episcleral vessels, proptosis and chemosis. Motility, visual acuity and fundus examination were normal. Neurological examination was also unremarkable. Given the subacute nature of the proptosis in association with engorged episcleral vessels, brain MRI and MRA were performed, demonstrating a right dural-cavernous sinus fistula. After two attempts via the femoral and facial veins, the dural fistula was accessed and treated via the right superior ophthalmic vein. The fistula was occluded and the symptoms regressed in 48 hours. Arteriography at 3 months confirmed a complete cure.