Endovascular Angioplasty And Stenting For Symptomatic And Severe Middle Cerebral Artery Stenosis

Background and PurposeIntracranial atherosclerotic stenosis, especially symptomatic middle cerebral artery stenosis is an important cause of ischemic stroke. The stroke rate is 7.0%-17.7%. Middle cerebral artery is a direct continuation of the internal carotid artery. There are many cortical branches supplying the outer side of the cerebral hemispheres including insula, temporal lobe, parietal lobe and basal ganglia district and other areas. Middle cerebral artery stenosis or occlusion due to various factors, usually cause corresponding hemodynamic disorders and stroke risk increases. Acute occlusion is more likely to lead to catastrophic large area infant of the ipsilateral cerebral hemisphere. In recent years, with the rapid development of non-invasive medical imaging technology, cerebrovascular disease detection rate is improved, especially intracranial vascular stenosis, which provide a reliable basis for the clinical diagnosis and treatment of the cerebrovascular diseaseTreatment means for symptomatic middle cerebral artery stenosis in clinical are including medication, surgical revascularization, endovascular balloon angioplasty and stent implantation. Among these, stenting being an effective way is carried out rapidly over the world. Fifty-three cases hospitalized suffering from transient ischemic attack (TIA) or cerebral infarction due to middle cerebral artery stenosis were collected between January 2011 and February,2012 in Henan Province People’s Hospital. Detailed clinical data, image data (MRI, CTPI, DSA, HRMRI), surgical records, and postoperative follow-up data were analyzed. Stenosis degree, perfusion parameter, NIHSS and mRS score were compared before, after and follow-up of the procedure.ResultsFifty-three cases of MCAS patients received stenting treatment using balloon-expandable stents (Apollo) or self-expanding stents (Wingspan). Technique success rate was 98.1%(52/53). Except rCBF, rCBV and rTTP improved significantly. There is no correlation between CTPI qualitative analysis and MRI infarct,Stenosis rate measured by the DSA and HRMR showed moderate consistency, The MCA diameter and stenosis degree changed significantly compared with those preoperative, No significant difference was found for NIHSS score and mRS score before surgery and after surgery, Perioperative complications were 7.5%, within 30 days of cumulative complication rate of 9.4 percent, one year cumulative incidence of complications were 11.3%(6/53), Following -up was done for 6-19 months, eight restenosis occurred, the stroke rate of 12.5%(5/32), there is significant difference for stenosis rate compared with the preoperative stenosis rate, but no significant difference with stenosis rate after surgery.ConclusionsThis study demonstrated that it is feasible that angioplasty and stenting for symptomatic middle cerebral artery stenosis. The technique success rate is high, perioperative complication is low, haemodynamics improved significantly and it can reduce the stroke rate. But the procedure is complex. The critical role still needs to be verified by prospective randomized controlled long-term follow-up studies.