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Intracranial stenting: which patients and when?

Asignificant cause of ischemic stroke is intracranial atherosclerotic disease caused by either hypoperfusion or distal embolization. The incidence has been reported to be 6% to 10% in whites, 6% to 22% in blacks, 11% in Hispanics, and 11% to 22% in Asians. Prognosis and morbidity for patients with intracranial stenosis vary widely, with the morbidity rate ranging from 10% to 46% per year, independent of medical therapy. The surgical option of an extracranial-to-intracranial bypass procedure has not been shown to be of significant benefit over optimal medical therapy for these patients. Over the past decade, a number of centers have been reporting their experience with intracranial angioplasty and stenting as a treatment option for patients in whom maximal medical therapy with antiplatelet and anticoagulant medications has failed. Although prospective randomized studies have not yet been performed, results from these centers have indicated that this procedure is technically feasible and that there are good preliminary data demonstrating efficacy.