Endovascular treatment of patients with intracranial stenosis with moyamoya-type collaterals

Sabareesh K Natarajan; Yuval Karmon; Rabih G Tawk; Erik F Hauck; L Nelson Hopkins; Adnan H Siddiqui; Elad I Levy

doi:10.1136/jnis.2011.004754

Endovascular treatment of patients with intracranial stenosis with moyamoya-type collaterals

¹Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
²Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
³Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo New York, New York, USA
⁴Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA

Correspondence to Elad I Levy, University at Buffalo Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, 3 Gates Circle, Buffalo, NY 14209, USA; elevy{at}ubns.com

Contributors Author Contributions Conceived and designed the research: EIL, SKNAcquired the data: All authorsAnalyzed and interpreted the data: SKN, YKPerformed statistical analysis: SKN, YKHandled funding and supervision: EILDrafted the manuscript: SKN, YKMade critical revision of the manuscript for important intellectual content: All authors.

Received 18 January 2011
Accepted 20 February 2011
Published Online First 15 March 2011

Abstract

Purpose The authors report the endovascular treatment of intracranial stenosis in six patients with moyamoya-type collaterals.

Patients All patients previously had experienced a stroke or transient ischemic attack. Lesion locations included a unilateral M1-segment lesion in five patients; and ipsilateral internal carotid artery (ICA)-T, M1 and A1 lesions with contralateral supraclinoid ICA stenosis in one patient. Mean M1 stenosis was 77.3±14.3%.

Results Six patients had balloon angioplasty; in one, a Wingspan stent deployed successfully after angioplasty failed to relieve the stenosis. Mean post-treatment stenosis was 41.0±33.0%. In one patient, vessel rupture occurring during angioplasty caused severe disability. Two patients were asymptomatic for 4 years and 6 months, respectively. One asymptomatic patient had severe restenosis re-treated with intracranial stenting. Two patients became symptomatic and had re-treatment at 1 and 2 months, respectively.

Conclusion Endovascular treatment of intracranial stenosis with moyamoya-type collaterals is possible but is associated with high rates of symptomatic restenosis and target-lesion revascularization.

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Footnotes

A portion of this work was presented at the 2010 International Stroke Conference, San Antonio Texas, USA, 24–26 February 2010.
Competing interests Disclosure of Competing Interests/Potential Conflicts of Interest. Dr Hopkins receives research study grants from Abbott (ACT 1 Choice), Boston Scientific (CABANA), Cordis (SAPPHIRE WW), and ev3/Covidien Vascular Therapies (CREATE) and a research grant from Toshiba (for the Toshiba Stroke Research Center); has an ownership/financial interest in AccessClosure, Boston Scientific, Cordis, Micrus and Valor Medical; serves on the Abbott Vascular Speakers' Bureau; receives honoraria from Bard, Boston Scientific, Cordis, and from the following for speaking at conferences – Complete Conference Management, Cleveland Clinic and SCAI; receives royalties from Cordis (for the AngioGuard device), serves as a consultant to or on the advisory board for Abbott, AccessClosure, Bard, Boston Scientific, Cordis, Gore, Lumen Biomedical and Toshiba; and serves as the conference director for Nurcon Conferences/Strategic Medical Seminars LLC. Dr Karmon has received a Fellowship Grant from the American Physicians Fellowship for Medicine in Israel. Dr Levy receives research grant support (principal investigator: Stent-Assisted Recanalization in acute Ischemic Stroke, SARIS), other research support (devices), and honoraria from Boston Scientific, and research support from Codman & Shurtleff, Inc. and ev3/Covidien Vascular Therapies; has ownership interests in Intratech Medical Ltd and Mynx/AccessClosure; serves as a consultant on the board of Scientific Advisors to Codman & Shurtleff, Inc.; serves as a consultant per project and/or per hour for Codman & Shurtleff, Inc., ev3/Covidien Vascular Therapies and TheraSyn Sensors, Inc.; and receives fees for carotid stent training from Abbott Vascular and ev3/Covidien Vascular Therapies. Dr Levy receives no consulting salary arrangements. All consulting is per project and/or per hour. Dr Siddiqui has received research grants from the National Institutes of Health (co-investigator: NINDS 1R01NS064592-01A1, Hemodynamic induction of pathologic remodeling leading to intracranial aneurysms) and the University at Buffalo (Research Development Award); holds financial interests in Hotspur, Intratech Medical, StimSox and Valor Medical; serves as a consultant to Codman & Shurtleff, Inc., Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting and Penumbra; belongs to the speakers' bureaus of Codman & Shurtleff, Inc. and Genentech; serves on an advisory board for Codman & Shurtleff; and has received honoraria from Abbott Vascular, American Association of Neurological Surgeons' courses, an emergency medicine conference, Genentech, Neocure Group LLC, an Emergency Medicine Conference, and from Abbott Vascular and Codman & Shurtleff, Inc. for training other neurointerventionists in carotid stenting and for training physicians in endovascular stenting for aneurysms. Dr Siddiqui receives no consulting salary arrangements. All consulting is per project and/or per hour. Neither Dr Hauck nor Dr Natarajan has disclosure information/potential conflicts of interest to report.
Ethics approval This study was conducted at Millard Fillmore Gates Hospital/Kaleida Health with the approval of the University at Buffalo Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.