Director of Neurosurgery The First Affiliated Hospital of Harbin Medical University, United States
Introduction: Intravascular stenting is an important method for the treatment of intracranial atherosclerotic stenosis. The treatment of small vessel ( < 2.5 mm) stenosis was a difficulty due to the difficulty of surgery. With the self-expanding stent system, the surgical successful rate has been further improved. However, there are no relevant reports on the use of self-expanding stents in the treatment of intracranial small vessel stenosis.
Methods: A retrospective analysis was performed on 32 patients with symptomatic intracranial small vessel stenosis who were treated with intracranial stents at our center from September 2021 to August 2023. Patients with a history of repeated TIA attacks or cerebral infarction locating in the corresponding blood supply area of the responsible blood vessel which is severe stenosis, and conventional drug treatment is ineffective. Immediate postoperative DSA was performed to evaluate the teatment effect. After the surgery, head CT, neurological examination and Rakin scale were reviewed to evaluate patients' prognosis. Telephone follow-up was conducted 1 month after surgery. DSA was performed 6 months after surgery.
Results: Among the 32 patients, 18 were male and 14 were female; the average age was (51 ± 11) years; 6 cases had anterior cerebral artery stenosis; 16 cases had superior middle cerebral artery stenosis; and 10 cases had inferior middle cerebral artery stenosis. A total of 33 intracranial stents were used in 32 patients.Among them, 100% (33/33) of the stents were successfully released. The average degree of stenosis decreased from (73.7±5.5)% preoperatively to (16.8±6.9)%. Five patients experienced symptomatic cerebral ischemic events during the perioperative period. No patient experienced perioperative intracranial hemorrhage. Postoperative follow-up of patients ranged from 2 to 15 months, with a median follow-up time of 6.6 months. A total of 26 cases (78.8%) were included, 4 patients with severe in-stent restenosis.
Conclusion : Intracranial stenting is safe and effective in the treatment of intracranial small vessel stenosis, and the short- and medium-term efficacy is satisfactory, but the long-term efficacy still needs further observation.
