Abstract
The purpose of this review article is to give an overview of the current development of intracranial stenting for treatment of atherosclerotic stenoses. Natural history and methods for diagnostic imaging are described as basis for the indication for endovascular treatment. Target group are patients with high-grade symptomatic stenoses > 70%. Technical standards for the use of self-expanding and balloon-expandable stents are reported together with the results of clinical case series. It seems to be difficult to drop acute complication rates (procedure-related stroke and death during the first 30 days) reliably from current levels of around 10% to values < 6%, which are more acceptable for a prophylactic procedure for the prevention of stroke. High restenosis rates up to 30% in the 1st year raised concerns about long-term efficacy. Further technical developments and improved criteria for patient selection are necessary to make intracranial stenting safer and more effective before a randomized trial (stent vs. medical treatment) may prove superiority of the endovascular approach.
Zusammenfassung
Das Ziel dieser Übersichtsarbeit ist es, einen Überblick über den derzeitigen Entwicklungsstand der intrakraniellen Stentbehandlung atherosklerotischer Stenosen zu geben. Daten zum Spontanverlauf und bildgebende Diagnostik werden als Grundlagen für die Indikationsstellung zur endovaskulären Behandlung beschrieben. Zielgruppe sind Patienten mit > 70%igen symptomatischen Stenosen. Berichtet wird über die technischen Standards bei der Verwendung von selbstexpandierenden und ballonexpandierbaren Stents und über die Ergebnisse der publizierten Fallserien. Es scheint dabei schwierig zu sein, von hohen periinterventionellen Komplikationsraten um 10% (Schlaganfall und Tod während der ersten 30 Tage) auf Werte < 6% zu senken, die für einen prophylaktischen Eingriff zur Verhütung eines Schlaganfalls besser akzeptabel sind. Hohe Restenoseraten bis zu 30% im 1. Jahr weckten Zweifel an der Langzeiteffektivität des Eingriffs. Weitere technische Verbesserungen und bessere Kriterien für die Patientenselektion sind notwendig, um die intrakranielle Stentimplantation sicherer und effektiver zu machen, bevor eine randomisierte Studie (Stent vs. medikamentöse Therapie) die Überlegenheit des endovaskulären Ansatzes belegen kann.
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* Dedicated to Professor Hermann Zeumer, MD, on the occasion of his 65th birthday and his retirement.
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Berkefeld, J., Zanella, F.E. Intracranial Stenting of Atherosclerotic Stenoses*. Clin Neuroradiol 19, 38–44 (2009). https://doi.org/10.1007/s00062-009-8039-7
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DOI: https://doi.org/10.1007/s00062-009-8039-7