Intracranial Stenting: Angioplasty Basic Technique, Indications, and Sizing: 2-Dimensional Operative Video.

Angioplasty Humans Intracranial Arteriosclerosis / diagnostic imaging Stents Stroke / surgery Thrombectomy
Intracranial atherosclerosis Intracranial stenting Mechanical thrombectomy Submaximal angioplasty

Journal

Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417

Informations de publication

Date de publication:
15 07 2021
Historique:
received: 06 10 2020
accepted: 22 02 2021
pubmed: 7 5 2021
medline: 3 8 2021
entrez: 6 5 2021
Statut: ppublish

Résumé

Intracranial atherosclerotic disease (ICAD) is a common cause of stroke. Antiplatelet therapy is the mainstay for symptomatic ICAD treatment. Endovascular management with submaximal angioplasty and/or intracranial stenting is reserved for patients with repeated ischemic events despite optimal medical therapy. We demonstrate intracranial angioplasty and stenting technique, technique indications, and sizing of stent and target vessel diameter. Stenting and angioplasty have been described in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis and Wingspan Stent System Post Market Surveillance trials.1,2 Submaximal angioplasty has also been described.3 This patient, who had been on dual antiplatelet therapy for several months, initially presented with occlusion of the left middle cerebral artery M2 inferior division and underwent mechanical thrombectomy with successful reperfusion. Postoperatively, the patient's symptoms did not improve. Medical management was optimized with heparin infusion. However, repeat stroke study demonstrated M2 inferior division reocclusion. A decision was made to proceed with intracranial angioplasty and stenting. P2Y12 levels were therapeutic. Under moderate conscious sedation, submaximal angioplasty of up to 80% of the normal M2 caliber was attempted. However, we observed persistent high-grade stenosis of the M2 inferior division. The major risk of crossing the lesion for angioplasty is vessel perforation. To safely perform this maneuver, we used a J-configured Synchro-2 microwire (Stryker). Because of the patient's recent thrombectomy, we also had prior tactile feedback about how much resistance was encountered while crossing the occlusion. We then deployed a balloon-mounted intracranial stent for optimal radial force across the stenotic area to restore perfusion. Postoperative computed tomography perfusion showed resolution of the previously noticed perfusion deficit. The patient gave informed consent for the procedures and video recording. Institutional review board approval was deemed unnecessary. Video. ©University at Buffalo Neurosurgery, September 2020. With permission.

Identifiants

DOI: 10.1093/ons/opab124 PMID: 33956956 PMC: PMC8343439
pubmed: 33956956
pii: 6271023
doi: 10.1093/ons/opab124
pmc: PMC8343439
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural Video-Audio Media

Langues

eng

Sous-ensembles de citation

IM

Pagination

E115-E116

Subventions

Organisme : NCATS NIH HHS
ID : KL2 TR001413
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2TR001413
Pays : United States

Investigateurs

Adam Arthur (A)
Mark Bain (M)
Bernard Bendock (B)
Mandy Jo Binning (M)
Alan S Boulos (AS)
Webster Crowley (W)
Richard Fessler (R)
Andrew Grande (A)
Lee Guterman (L)
Ricardo Hanel (R)
Daniel Hoit (D)
L Nelson Hopkins (LN)
Jay Howington (J)
Robert James (R)
Brian Jankowitz (B)
Peter Kan (P)
Alex A Khalessi (AA)
Louis Kim (L)
David Langer (D)
Giuseppe Lanzino (G)
Michael Levitt (M)
Elad I Levy (EI)
Demetrius Lopes (D)
William Mack (W)
Robert Mericle (R)
J Mocco (J)
Chris Ogilvy (C)
Aditya Pandey (A)
Robert Replogle (R)
Howard Riina (H)
Andrew Ringer (A)
Rafael Rodriguez (R)
Eric Saugaveau (E)
Clemens Schirmer (C)
Adnan H Siddiqui (AH)
Alex Spiotta (A)
Ali Sultan (A)
Rabih Tawk (R)
Ajith Thomas (A)
Raymond Turner (R)
Erol Veznedaroglu (E)
Babu Welch (B)
Jonathan White (J)

Informations de copyright

© Congress of Neurological Surgeons 2021.

Références

Lancet. 2014 Jan 25;383(9914):333-41
pubmed: 24168957
J Neurosurg. 2016 Oct;125(4):964-971
pubmed: 26745485
Stroke. 2019 Apr;50(4):889-894
pubmed: 31125298

Auteurs

Rimal H Dossani (RH)

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.

Muhammad Waqas (M)

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.

Justin M Cappuzzo (JM)

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.

Ashish Sonig (A)

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.

Adnan H Siddiqui (AH)

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.
Jacobs Institute, Buffalo, New York, USA.

Elad I Levy (EI)

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.
Jacobs Institute, Buffalo, New York, USA.

Jason M Davies (JM)

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.
Jacobs Institute, Buffalo, New York, USA.
Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
ORCID: 0000-0002-5225-3072

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Classifications MeSH

Recherchemedicale.com › Techniques d'investigation › Cathétérisme › Angioplastie › Intracranial Stenting: Angioplasty Basic...
Recherchemedicale.com › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Intracranial Stenting: Angioplasty Basic...
Recherchemedicale.com › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Artériopathies intracrâniennes › Artériosclérose intracrânienne › Intracranial Stenting: Angioplasty Basic...
Recherchemedicale.com › Équipement et fournitures › Prothèses et implants › Endoprothèses › Intracranial Stenting: Angioplasty Basic...
Recherchemedicale.com › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Intracranial Stenting: Angioplasty Basic...
Recherchemedicale.com › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Thrombectomie › Intracranial Stenting: Angioplasty Basic...