Original Paper
Failure of Primary Percutaneous Angioplasty and Stenting in the Prevention of Ischemia in Moyamoya AngiopathyKhan N.a · Dodd R.a, b · Marks M.P.a, b · Bell-Stephens T.a · Vavao J.a · Steinberg G.K.aDepartments of aNeurosurgery and bRadiology, Stanford Stroke Center, and Stanford Institute for Neuro-Innovation and Translational Neurosciences, Stanford University School of Medicine, Stanford, Calif., USA
Keywords: AngioplastyMoyamoyaWingspan stent |
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Article / Publication Details
Received: June 18, 2010
Accepted: August 02, 2010
Published online: December 04, 2010
Issue release date: January 2011
Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 1
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
Abstract
Background: Moyamoya disease (MMD) is an idiopathic progressive arteriopathy affecting the proximal intracranial vasculature. To date only 4 case reports on intracranial angioplasty or stenting as treatment of this disease exist. We present 5 adult patients with MMD who failed angioplasty and/or stenting who remained symptomatic despite endovascular treatment or presented with recurrent symptoms and recurrence of stenosis/occlusion on angiography requiring subsequent extracranial-intracranial revascularization. Methods: Five adult MMD patients who underwent endovascular treatment with angioplasty or stenting were referred for further evaluation and treatment from outside hospitals. Data were collected from clinical referral notes and angiograms or reports. All patients underwent repeat 6-vessel cerebral angiography to assess the extent of disease and results of prior endovascular treatment. Results: Six endovascular procedures were performed in all 5 patients. Internal carotid artery (ICA) balloon angioplasty and Wingspan stenting was performed in 2 patients (3 arteries). One patient had ICA-M1 angioplasty without stenting. Two patients had M1 angioplasty and Wingspan stenting. All patients developed repeat transient ischemic attacks following treatment attributable to the vascular territories of endovascular treatment. Repeat endovascular treatment was performed in 3 patients at a mean of 4 months (range = 2–6). Two went on to a third endovascular treatment due to progression of disease in the angioplastied/stented vessel. The average time of symptom recurrence after initial endovascular therapy was 1.8 months (0–4 months). Follow-up angiography when referred to our institution demonstrated 70–90% instent restenosis of the stented vessel in 3 and occlusion in 1 patient. Due to persistence of symptoms cerebral revascularization was performed in all patients. Conclusion: MMD is a progressive angiopathy. Angioplasty and stenting may temporarily improve the cerebral blood flow and decrease cerebral ischemic events but do not appear to be durable nor provide long-term prevention against future ischemic events.
© 2010 S. Karger AG, Basel
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Article / Publication Details
Received: June 18, 2010
Accepted: August 02, 2010
Published online: December 04, 2010
Issue release date: January 2011
Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 1
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
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