3 Case of Intracranial Stenosis Treated by Neurospeed Balloon and Low-Profile Stent, after Failure of Best Medical Treatment

Background: Intracranial vascular stenosis became a significant cause of acute ischemic stroke and recently the prevalence of this condition has been found to be 31% in an elderly population with common cardiovascular risk factors, with a percentage of vascular stenosis > 50% in 9% of cases. In this short series, we report optimal technical success (100%) of endovascular treatment of intracranial symptomatic vascular stenosis employing a novel technique as low profile stent (the neuroform atlas or Credo) in combination with neurospeed balloon.

Materials and Methods: Three patients were admitted to our stroke units with recurrent TIA or stroke. All three patients had a history of known intracranial stenosis of over 75%, treated in the previous months with the best medical therapy (double antiplated and statin). Before endovascular treatment (EVT) procedure, informed consent was obtained; if the patient was unable to give explicite consent, the accompanying relatives were in any case made aware of the procedure. Clinical status at follow-up was assessed by an experienced neurologist and neuroradiologist who jointly evaluated clinical and imaging data. All endovascular procedures were performed in our two-center institution under general anesthesia and by one or two senior interventional neuroradiologists. The procedures were all performed in triaxial technique using a 6-F long sheath (Neuron Max 088 Penumbra, United States). All patient received preliminary angioplasty with neuroSpeed ballon catheter(acandis). The intracranial stents (one neuroform atlas and two credo) were released by NeuroSpeed ballon catheter. All patients were subsequently assessed with a neurological examination.

Results: In all patients, the procedure was successful without any complications. Immediate follow-up demonstrated good size of the vessels with complete resolution of the stenosis. No restenosis in the 1-month follow up. All patients made a full recovery within 1 week.

Conclusion: In our preliminary experience, we obtained encouraging clinical and angiographic results in endovascular treatment of IS due to atheromatous disease with a novel intracranial stenting technique with Neuroform Atlas stent or credo stent with Neurospeed PTA balloon catheter. More data are mandatory to confirm and evaluate the real clinical benefit of endovascular treatment of IS and specifically the novel technique presented. Especially if, in the near future, we would like to start treating patients with severe symptomatic intracranial stenosis, before the best medical has failed.

Publication History

Article published online:
14 December 2021