Clinical and basic research of the endovascular therapy for intracranial atherosclerotic lesion

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Endovascular therapy for intracranial atherosclerotic stenosis is novel treatment recently developed. However, there still exist several problems to be solved. We studied long term follow-up results of percutaneous transluminal angioplasty and effect of stenting for this disorder in clinical cases. In basic research, the patency of the perforating artery of the intracranial artery was studied when intracranial stenting was performed.(1)Clinical research : Endovascular therapy was performed in 45 cases with intracranial atherosclerotic stenosis. 44 cases were successfully treated with endovascular therapy. In ten cases, stenting was tried and successful results were obtained in eight cases but failed in two cases due to the tortuosity of the artery. Significant dilatation was obtained in stent group(80 % stenosis to 4 % stenosis)compared with PTA group(75% stenosis to 27 % stenosis). Restenosis also tends to be reduced in stent group without statistical significance. Two complications w … More ere encountered in stent-tried group, one was stent migration which needed retrieval with a snare wire, and the other was stent thrombosis which was terated with emergent PTA and fibrinolysis. Two hemorrhagic complication appeared in PTA group, one hyperperfusion hemorrhage and one rupture of the associated aneurysm. Four ischemic complication occurred in 45 patients but two were transient and two minor stroke. No new lesion-related ischemic stroke was not encountered in mean 29-months follow-up period. Endovascular therapy was effective for stroke prevention, although there exist 9% procedure-related complication.(2)Basic research : In rabbits, their abdominal aorta is nearly 3 mm in diameter and lumbar arteries, 500 microns in average diameter, merges from the aorta. This anatomical situation is very similar to that of human intracranial artery, such as the middle cerebral artery or basilar artery. We deployed stents into the rabbits' abdominal aorta to cross the lumbar arteries. The patency of the lumbar artery was examined angiography as well as scanning electron microscopy three months after the treatment in eight rabbits. In all rabbits, lumbar arteries were kept patent and endothelial-like cells covered the strut. Less