Abstract

The SAMMPRIS Trial showed that medical treatment of intracranial stenosis is safer than intracranial angioplasty and stenting (IAS). One of the reasons for the worse outcome with IAS was the occurrence of ipsilateral cerebral hemorrhage, which may be associated with an intracranial exchange maneuver. Newly developed mini intracranial stents may enhance the safety of IAS by obviating the need for this maneuver. We retrospectively evaluated 7 intracranial stenoses (6 patients, 5 men, mean age 57) which were treated with an Atlas stent. In 5 cases there was a high-grade atherosclerotic stenosis which did not optimally respond to medical treatment, one patient had radiotherapy induced stenosis and in one patient there was a chronic arterial dissection with a distal aneurysm. All lesions were located in the petrocavernous segment of the internal carotid artery. All of the procedures were performed electively under dual antiplatelet therapy and general anesthesia. After performing angioplasty of the stenosis with an over-the-wire balloon (e.g. Gateway balloon), the Atlas stent was delivered directly through the lumen of the angioplasty balloon, without a need for an intracranial exchange maneuver.The procedure was successful in all patients. There was no mortality or permanent morbidity related to the procedures. At a mean follow-up of 9.8 months (range 1–18 months ), there was one case of asymptomatic occlusion and otherwise no evidence of restenosis. None of the patients suffered a recurrent ipsilateral stroke.Although further studies are needed for demonstrate safety and efficacy of self-expandable mini stents in IAS, our results indicate that a single step angioplasty/stenting is feasible with these devices. We suggest the optimization of the currently available over-the-wire balloons for this technique.