Cerebrovascular Stents May Improve Outcomes of Patients with Stroke Symptoms, According to Pittsburgh Study
PITTSBURGH, June 5, 2001 — Stent-assisted angioplasty may alleviate symptoms, increase blood flow to the brain and improve the typically poor prognosis of patients with stroke symptoms from arterial blockages that occur in the rear of the brain, according to a study published in the June issue of Neurosurgery.
The findings suggest that stents, small metallic cages inserted into the basilar or vertebral arteries (located in the back of the neck), of these patients after they have undergone angioplasty to clear away blockage (stenosis), may be an alternative treatment to bypass surgery or angioplasty alone.
"These strokes are difficult to treat. Blockage of these arteries portends a poor prognosis for patients, with 5 to 11 percent experiencing irreversible neurological deterioration or death," said Michael Horowitz, M.D., associate professor in the department of neurological surgery and radiology at the University of Pittsburgh School of Medicine. "Our study results demonstrate that stent-assisted angioplasty is an option for high-risk surgical patients."
For surgical management of basilar or vertebral artery stenosis, the combined mortality and morbidity rate is 34 percent, while angioplasty of these arteries without stenting leads to restenosis in 20 to 30 percent of patients.
The retrospective study, by the University of Pittsburgh and the University of Texas Southwestern Medical Center, examined the outcomes of 11 patients with stroke symptoms who underwent angioplasty and stenting of either the vertebral or basilar arteries. All of the patients in the study had transient ischemic attacks, or fixed deficits that failed to respond to medical treatment. Their symptoms included headache, facial droop, loss of coordination, vertigo and depressed mental status.
After a follow-up period of four months, seven of the patients no longer had recurrent symptoms, lived at home and resumed activities at the same or better levels compared with before the procedure. The remaining four patients died either from complications during the procedure or several months after the procedure. Two of the four patients experienced a fatal rupture of the vertebral or basilar artery, the third had a stroke and died three months later, and the procedure on the fourth patient resulted in brain death.
"Although this study demonstrates the potential for stent-assisted angioplasty, it also demonstrates the risks associated with dilation of stenotic, often fragile, diseased vessels," said Dr. Horowitz. "Long-term follow-up is needed to determine whether this treatment will improve on the natural history of the disease with medical management alone."
Recent advances in stent technology have led to the development of a new generation of stents that allow neuroradiologists to better negotiate the arteries in the back of the neck.
"Cerebrovascular stents were first used for stent-assisted coil treatment of aneurysms," said Charles C. Jungreis, M.D., neuroradiologist at the University of Pittsburgh. "The technique of stent-assisted angioplasty is still in its infancy and the benefit/risk ratio of this procedure will improve as newer devices are developed."