Treatment Of Intracranial Arterial Stenosis Research Articles

Balloon Expandable Stents Versus Self-expanding Stents for Treatment of Intracranial Arterial Stenosis: A Systematic Review and Meta-analysis (P1-5.022)

Balloon Expandable Stents Versus Self-expanding Stents for Treatment of Intracranial Arterial Stenosis: A Systematic Review and Meta-analysis (P1-5.022)

Enterprise stents for the treatment of symptomatic non-acute intracranial artery stenosis disease: safety and efficiency evaluation

ABSTRACT Background Enterprise stent was approved for the treatment of wide-necked intracranial aneurysms. However, it has been widely used in the endovascular treatment of intracranial artery stenosis, which is still controversial. The purpose of this study was to evaluate the safety and efficiency of the Enterprise stent in the endovascular treatment of intracranial artery stenosis disease. Methods We conducted a retrospective case series of 107 patients with intracranial artery stenosis who received Enterprise stent implantation at Nanjing Drum Tower Hospital from January 2020 to December 2022. The rates of recanalization, perioperative complications, in-stent restenosis at 3–12 months and stroke recurrence were assessed for endovascular treatment. Results A total of 107 individuals were included in this study, 88 were followed up, and 19 (17.8%) patients were lost to follow-up. The operation success rate was 100%, During the procedure,4（3.7%）patients had vasospasm, and 2(1.9%) patients showed symptomatic bleeding. The overall perioperative complication rate was 5.6%, including 2.8% distal artery embolism, 0.9% in-stent thrombosis, and 1.9% symptomatic bleeding. 88 (82.2%) patients were followed up from 3 to 12 months, of whom 12 (13.6%) had in-stent restenosis, 4 (4.7%) recurrent strokes and 2 died of pulmonary infection caused by COVID-19. Patients were divided into 3 groups according to the cerebral artery, including the middle cerebral artery group, internal carotid artery group, and vertebrobasilar artery group. Conclusions In this study, the placement of the Enterprise stent in patients with symptomatic non-acute intracranial stenosis was successful. However, the occurrence of periprocedural and long-term complications after stenting remains of high concern.

Abstract TP174: Balloon Expandable Stents versus Self-Expanding Stents for Treatment of Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis

Background: There is limited data regarding the comparison of balloon-expanding stents (BES) and self-expanding stents (SES) for the treatment of intracranial arterial stenosis. Methods: We conducted a systematic review to identify studies that compared SES and BES in patients with symptomatic intracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until May 2023. Statistical pooling with random-effects meta-analysis was undertaken to compare the rates/severity of post-procedure stenosis, technical success, stroke and/or mortality, long-term events, and restenosis rates between BES and SES. Results: A total of 20 studies were included. The standardized mean difference (SMD) for post-procedure stenosis (%) was significantly lower (SMD: -0.52, 95% confidence interval [CI]: -0.79 to -0.24, p < 0.001, 10 studies involving 1515 patients) with BES. The odds for technical success were non-significantly lower (odds ratio [OR]: 0.99, 95% CI 0.43-2.26, p = 0.983, 9 studies involving 1001 patients) with BES. The odds for post-procedure 30-day stroke and/or death were significantly lower (OR 0.68, 95% CI: 0.50-0.94, p = 0.019, 15 studies involving 2431 patients), and stroke and/or death beyond 30 days were non-significantly lower (OR 0.64, 95% CI: 0.30-1.37, p = 0.250, 10 studies involving 947 patients) with BES. The odds for restenosis rate were significantly lower (OR 0.50, 95% CI: 0.31-0.80, p = 0.004, 13 studies involving 1115 patients) with BES. Conclusions: Compared with SES, BES was associated with lower rates of post-procedure 30-day stroke and/or death presumably due to less severe post-procedure stenosis in the treatment of symptomatic intracranial arterial stenosis.

Self-expanding versus balloon expandable stent for intracranial arterial stenosis: A systematic review and meta-analysis.

There are limited data regarding the comparison of balloon expandable stents (BES) and self-expanding stents (SES) for the treatment of intracranial arterial stenosis. We conducted a systematic review to identify studies that compared SES and BES in patients with symptomaticintracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until from January 1, 2010 to September 28, 2023. Statistical pooling with random-effects meta-analysis was undertaken to compare the rates/severity ofpostprocedure stenosis, technical success, 30-day stroke and/or death, cumulative clinical endpoints, and restenosis rates. A total of 20 studies were included.The standardized mean difference (SMD) for postprocedure stenosis (%) was significantly lower (SMD: -0.52, 95% confidence interval [CI]: -0.79 to -0.24, p < .001, 10 studies involving 1515 patients) with BES. The odds for 30-day stroke and/or death were significantly lower (odds ratio [OR] 0.68, 95% CI: 0.50-0.94, p = .019, 15 studies involving 2431 patients), and cumulative clinical endpoints on follow-up were nonsignificantly lower (OR 0.64, 95% CI: 0.30-1.37, p = .250, 10 studies involving 947 patients) with BES. The odds for restenosis during follow-up were significantly lower (OR 0.50, 95% CI: 0.31-0.80, p = .004, 13 studies involving 1115 patients) with BES. Compared with SES, BES were associated with lower rates of postprocedure 30-day stroke and/or death with lower rates of restenosis during follow up andthe treatment of symptomatic intracranial arterial stenosis.

Endovascular therapy versus medical treatment for symptomatic intracranial artery stenosis.

Intracranial artery stenosis (ICAS) is an arterial narrowing in the brain that can cause stroke. Endovascular therapy (ET) and conventional medical treatment (CMT) may prevent recurrent ischaemic stroke caused by ICAS. However, there is no consensus on the best treatment for people with ICAS. To evaluate the safety and efficacy of endovascular therapy plus conventional medical treatment compared with conventional medical treatment alone for the management of symptomatic intracranial artery stenosis. We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, four other databases, and three trials registries on 16 August 2022. We contacted study authors and researchers when we required additional information. We included randomised controlled trials (RCTs) comparing ET plus CMT with CMT alone for the treatment of symptomatic ICAS. ET modalities included angioplasty alone, balloon-mounted stent, and angioplasty followed by placement of a self-expanding stent. CMT included antiplatelet therapy in addition to control of risk factors such as hypertension, hyperlipidaemia, and diabetes. Two review authors independently screened the records to select eligible RCTs, then extracted data from them. We resolved any disagreements through discussion, reaching consensus decisions among the full team. We assessed risk of bias and applied the GRADE approach to assess the certainty of the evidence. The primary outcome was death by any cause or non-fatal stroke of any type within three months of randomisation. Secondary outcomes included all-cause death or non-fatal stroke of any type occurring more than three months after randomisation, ipsilateral stroke, transient ischaemic attack, ischaemic stroke, haemorrhagic stroke, death, restenosis, dependency, and health-related quality of life. We included four RCTs with 989 participants who had symptomatic ICAS, with an age range of 18 to 85 years. We identified two ongoing RTCs. All trials had high risk of performance bias, as it was impossible to blind participants and personnel to the intervention. Three trials were terminated early. One trial was at high risk of attrition bias because of substantial loss to follow-up after one year and a high proportion of participants transferring from ET to CMT. The certainty of evidence ranged from low to moderate; we downgraded for imprecision. Compared to CMT alone, ET plus CMT probably increases the risk of short-term death or stroke (risk ratio (RR) 2.93, 95% confidence interval (CI) 1.81 to 4.75; 4 RCTs, 989 participants; moderate certainty), short-term ipsilateral stroke (RR 3.26, 95% CI 1.94 to 5.48; 4 RCTs, 989 participants; moderate certainty), short-term ischaemic stroke (RR 2.24, 95% CI 1.30 to 3.87; 4 RCTs, 989 participants; moderate certainty), and long-term death or stroke (RR 1.49, 95% CI 1.12 to 1.99; 4 RCTs, 970 participants; moderate certainty). Compared to CMT alone, ET plus CMT may increase the risk of short-term haemorrhagic stroke (RR 13.49, 95% CI 2.59 to 70.15; 4 RCTs, 989 participants; low certainty), short-term death (RR 5.43, 95% CI 1.21 to 24.40; 4 RCTs, 989 participants; low certainty), and long-term haemorrhagic stroke (RR 7.81, 95% CI 1.43 to 42.59; 3 RCTs, 879 participants; low certainty). It is unclear if ET plus CMT compared with CMT alone has an effect on the risk of short-term transient ischaemic attack (RR 0.79, 95% CI 0.30 to 2.07; 3 RCTs, 344 participants; moderate certainty), long-term transient ischaemic attack (RR 1.05, 95% CI 0.50 to 2.19; 3 RCTs, 335 participants; moderate certainty), long-term ipsilateral stroke (RR 1.78, 95% CI 1.00 to 3.17; 4 RCTs, 970 participants; moderate certainty), long-term ischaemic stroke (RR 1.56, 95% CI 0.77 to 3.16; 4 RCTs, 970 participants; moderate certainty), long-term death (RR 1.61, 95% CI 0.77 to 3.38; 4 RCTs, 951 participants; moderate certainty), and long-term dependency (RR 1.51, 95% CI 0.93 to 2.45; 4 RCTs, 947 participants; moderate certainty). No subgroup analyses significantly modified the effect of ET plus CMT versus CMT alone. The trials included no data on restenosis or health-related quality of life. This review provides moderate-certainty evidence that ET plus CMT compared with CMT alone increases the risk of short-term stroke and death in people with recent symptomatic severe ICAS. This effect was still apparent at long-term follow-up but appeared to be due to the early risks of ET; therefore, there may be no clear difference between the interventions in terms of their effects on long-term stroke and death. The impact of delayed ET intervention (more than three weeks after a qualifying event) warrants further study.

Long-term outcome and factors associated with restenosis after combination therapy of balloon angioplasty and stenting for symptomatic intracranial stenosis

BackgroundThe optimal treatment for intracranial artery stenosis (ICAS) has not been established. We retrospectively examined the initial and long-term outcomes associated with restenosis of a combination therapy of balloon angioplasty and stenting for symptomatic atherosclerotic ICAS.MethodsConsecutive patients who underwent balloon angioplasty and/or stenting for ≥ 70% ICAS between 2006 and 2020 were analyzed. Patients within 48 h of stroke onset were excluded. The following procedures were established as standards at our institution: (1) primary balloon angioplasty alone was initially performed; (2) stenting for insufficient dilatation, recoiling, or dissection was conducted; and (3) stenting was considered for restenosis. Intracranial ischemic and hemorrhagic complications within 30 days after treatment were used to evaluate periprocedural safety. Recurrent ischemic events, restenosis and restenosis related factors were used to be evaluate the long-term outcome.ResultsA total of 160 patients were recruited. Initial treatment consisted of balloon angioplasty (n = 101) and stenting (n = 59). Intracranial complications within 30 days after treatment were ischemic in five (3.1%) and hemorrhagic in four patients (2.5%). The incidence of these complication was 3.1% in the stenting group and 2.5% in the balloon angioplasty group. The mean follow-up period was 53.9 months. Restenosis was found in 42 patients (26%). Recurrent ischemic events during follow-up were noted in 14 patients (8.8%), of which six patients had TIA and eight patients had ischemic stroke. Restenosis-associated factors included diabetes, coronary artery disease, percent stenosis after treatment, and balloon angioplasty in logistic univariate analysis. Multivariate Cox regression analysis showed that diabetes (HR: 2.084, CI: 1.039–4.180, p = 0.0386), length of lesion (HR; 1.358, CI: 1.174–1.571, p < 0.0001), and balloon angioplasty (HR: 4.194, CI: 1.083–16.239, p = 0.0379) were independent predictors for restenosis.ConclusionCombination therapy of balloon angioplasty and stenting for symptomatic ICAS had a low perioperative stroke rate and may improve long-term outcome. Balloon angioplasty, diabetes, and length of lesion were significantly associated with restenosis.

Visualization of Four Intracranial Stents and In-stent Stenosis with Stenotic Models by 3D-TOF-MRA

In recent years, various types of stents are deployed for the treatment of intracranial artery stenosis and aneurysms. Digital subtraction angiography has been considered to be the gold standard for the follow-up study. However, magnetic resonance angiography (MRA) is less invasive and the recent advances may contribute to the imaging of patients with intracranial stents. Then, a phantom study was carried out to evaluate the MR lumen visibility with these stents. Four stents [low-profile visualized intraluminal support (LVIS), Neuroform Atlas, Neuroform EZ, and Enterprise 2] were placed into plastic tubes with 3 mm inner diameter, and fixed in a container filled with agar. Time-of-flight MRA (TOF-MRA) was performed for these stents, and the signal intensities inside and outside the stents were measured on ImageJ software. Furthermore, 25%, 50%, and 75% stenosis models were created and passed through these stents to evaluate the diagnostic accuracy of in-stent stenosis. The signal intensity inside the LVIS stent was the highest among the four stents (P<0.001), and no significant difference was found between the signal intensities inside and outside the LVIS stent. The diagnostic accuracy with LVIS was also higher than that of Enterprise 2 (P<0.001). In conclusion, the visibility with LVIS indicates that TOF-MRA could be reliably utilized as a diagnostic tool for the detection of in-stent stenosis.

Intracranial artery stenosis: Current status of evaluation and treatment in China

Intracranial artery stenosis (ICAS), a common cause of ischemic stroke, is a growing cause of concern in China. Recently, many epidemiological, etiological, pathophysiological, therapy, and diagnostic imaging studies have focused on ICAS, and guidelines and consensus on the diagnosis and treatment of ICAS have been published and updated by domestic experts. Such work is pivotal to our enhanced comprehension, diagnosis, and treatment of ICAS. In this review, we summarize the latest progress in the evaluation and treatment of ICAS in China.

Influence of Bifurcation Angle on In-Stent Restenosis at the Vertebral Artery Origin: A Simulation Study of Hemodynamics

Endovascular surgery has become one of the main methods for treatment of intracranial arterial stenosis. Its safety and efficacy has been greatly improved. However, in-stent restenosis (ISR) remains a major problem challenging interventional treatment. In this paper, the formation of ISR at the proximal end of stent was concerned from the aspects of the effect of bifurcation angle. Five realistic models with different bifurcation angle (44.49°, 74.72°, 80.53°, 86.10° and 95.37°) were built by using Mimics. Computational fluid dynamics was used to analyze the influence of vertebral artery bifurcation angle on the ISR. The area of low wall shear stress (WSS, <1.5 Pa) at the proximal end of vertebral artery extracted at the systole in the five models were 1.05, 1.08, 3.90, 2.98 and 1.05e−4 m2 respectively. The area of low WSS extracted at the diastole were 2.17, 3.26, 2.43, 2.66 and 2.89e−4 m2 respectively. Moreover, the time-averaged WSS of the five models were 4.19, 3.78, 5.01, 3.78 and 4.15 Pa respectively. Overall, with the increase of bifurcation angle, the area of lesion is prone to increase: the contact of blood particles with the luminal surface will be prolonged. The area of low WSS in the model with the bifurcation angle of 74.72° is particularly high and this model is perhaps the most prone to restenosis.

Regulatory Science in the Review of Drugs and Medical Devices

The review of drugs and medical devices is an integral part of regulatory science. The Pharmaceuticals and Medical Devices Agency (PMDA) evaluates the efficacy, safety, and quality of drugs and medical devices after applications are submitted for regulatory approval. The products are approved when their benefits exceed their risks, i.e., an application is approved if the efficacy of the product in patients was demonstrated and the safety of the product is acceptable in view of its observed benefits. However, drugs and medical devices for which efficacy was not clearly demonstrated in clinical trials makes the decision to approve a difficult process. Under those circumstances, the approval process is based on the totality of information, such as the reason why clinical trials did not succeed and medical needs in Japan. The Wingspan stent system, which was approved for the treatment of intracranial arterial stenosis, is an example of a product with a use different from that intended by the US Food and Drug Administration and PMDA.

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There is an ongoing discussion about reimbursement of stent-angioplasty for the treatment of intracranial stenoses in Germany. The discussion was initiated by the statutory health insurance companies after publication of the SAMMPRIS study results, which were in favor for medical management compared to stent-angioplasty with the Wingspan® stent system. A report (Rapid report N14-01) mainly based on SAMMPRIS was written by the German Institute for Quality and Efficiency in Health Care (IQWiG) and serves as a basis for the decision-making process. This report was previously commented by the medical societies involved. Limitations of the SAMMPRIS trial and vital indications for intracranial stenting were outlined in this comment (acute vessel occlusion, hemodynamic impairment, recurrent symptoms under medical treatment). Currently also emergency stent procedures are a matter of debate. In this context a second IQWiG report was commissioned (GA 15 - 02) addressing the results of the VISSIT trial, the transferability of the results of the first report to emergency treatments and the practice of emergency intracranial stent treatment in Germany. Regarding transferability of results the main conclusion was that there was no evidence that the results of the studies analyzed for the first report (mainly SAMMPRIS) could not be transferred to emergency treatments. From a medical professional and scientific standpoint it is inacceptable to compare outcomes of a secondary prophylactic treatment with emergency procedures. The analysis of emergency treatments in Germany based on retrospective case series with a cumulative number of 31 patients. Since most emergency procedures are performed in a clinical context and are not necessarily subject to scientific evaluation, this does not reflect current practice in Germany. The first part of this statement briefly outlines the design of SAMMPRIS and VISSIT and the interpretation of the trial results from a professional perspective. The current state of discussion regarding reimbursement of intracranial stenting is summarized. The second section contains a detailed comment on the current IQWiG report GA15-02 "Stents for the treatment of intracranial artery stenosis: VISSIT study and acute treatment in Germany".

IQWiG Arbeitspapier GA15-02: „Stents zur Behandlung intrakranieller Stenosen: VISSIT Studie und Akutbehandlung in Deutschland“

There is an ongoing discussion about reimbursement of stent-angioplasty for the treatment of intracranial stenoses in Germany. The discussion was initiated by the statutory health insurance companies after publication of the SAMMPRIS study results, which were in favor for medical management compared to stent-angioplasty with the Wingspan® stent system. A report (Rapid report N14-01) mainly based on SAMMPRIS was written by the German Institute for Quality and Efficiency in Health Care (IQWiG) and serves as a basis for the decision-making process. This report was previously commented by the medical societies involved. Limitations of the SAMMPRIS trial and vital indications for intracranial stenting were outlined in this comment (acute vessel occlusion, hemodynamic impairment, recurrent symptoms under medical treatment).Currently also emergency stent procedures are a matter of debate. In this context a second IQWiG report was commissioned (GA 15 - 02) addressing the results of the VISSIT trial, the transferability of the results of the first report to emergency treatments and the practice of emergency intracranial stent treatment in Germany6. Regarding transferability of results the main conclusion was that there was no evidence that the results of the studies analyzed for the first report (mainly SAMMPRIS) could not be transferred to emergency treatments. From a medical professional and scientific standpoint it is inacceptable to compare outcomes of a secondary prophylactic treatment with emergency procedures. The analysis of emergency treatments in Germany based on retrospective case series with a cumulative number of 31 patients. Since most emergency procedures are performed in a clinical context and are not necessarily subject to scientific evaluation, this does not reflect current practice in Germany.The first part of this statement briefly outlines the design of SAMMPRIS and VISSIT and the interpretation of the trial results from a professional perspective. The current state of discussion regarding reimbursement of intracranial stenting is summarized. The second section contains a detailed comment on the current IQWiG report GA15-02 "Stents for the treatment of intracranial artery stenosis: VISSIT study and acute treatment in Germany".

Current Management of Symptomatic Intracranial Stenosis

Intracranial arterial stenosis (IAS) is the cause of about 10% of all ischemic strokes in the United States, but may account for about 40% of strokes in some populations. After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin is no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death. Groups with the highest risk of recurrent stroke are those with high-grade (≥ 70%) stenosis, those with recent symptom onset, those with symptoms precipitated by hemodynamic maneuvers, and women. Endovascular treatment of IAS is a rapidly evolving therapeutic option. Antiplatelet agents are currently recommended as the primary treatment for symptomatic IAS, with endovascular therapy reserved for appropriate high-risk cases refractory to medical therapy.

Treatment of symptomatic intracranial artery stenosis with Wingspan stent

Objective To study the role of wingspan stent in treatment of intracranial arterial stenosis,including its feasibility,safety,efficacy and operating skills.Method27 cases of intracranial arterial stenosis treated with wingspan stent was retrospectively studied.There was no response to drug control in all patients.The stenosis located in 3 internal arteries,13 middle cerebral arteries,4 vertebral arteries and 7 basal arteries.Results All stents were successfully deployed with satisfied opening of the narrow paragraph.All patients were followed up after the procedures.There was I case of occasional attack of TIA,1 case of asymptomatic cerebral infarction.There was no ischemic attack occurred in other patients.Conclusions Wingspan stent is safe and effective in treatment of intracranial artery stenosis. Key words: Cerebralvascular disorders; Carotid stenosis; Stents; Wingspan

Long term clinical and angiographic outcomes with the Wingspan stent for treatment of symptomatic 50–99% intracranial atherosclerosis: single center experience in 51 cases

Background and aimTwo independent post-approval registries have reported favorable periprocedural and short term outcomes with the use of the Wingspan stent for treatment of intracranial arterial stenosis. Data on long...

Current management of symptomatic intracranial stenosis: Medical versus endovascular therapy

Approximately 8% to 10% of all ischemic strokes are caused by intracranial arterial stenosis (IAS). After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin has been shown to be no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death. Groups with the highest risk of recurrent stroke are those with high-grade (> or = 70%) stenosis, those with recent symptom onset, and women. Endovascular treatment of IAS is a rapidly evolving therapeutic option. Antiplatelet agents are currently recommended as the primary treatment for symptomatic IAS, with endovascular therapy reserved for appropriate high-risk cases refractory to medical therapy.

Treatment of intracranial arterial stenosis

Intracranial stenosis accounts for 8–10% of ischemic strokes in the USA. Treatment of intracranial stenosis with extracranial-to-intracranial bypass surgery was investigated as a therapy in the 1980s, but was shown to be no better than aspirin alone. The Warfarin vs Aspirin for Symptomatic Intracranial Disease study found a 12% per year risk of recurrent stroke for symptomatic lesions of 50% or higher, with the majority of strokes occurring in the first year. Warfarin was no better than aspirin in the prevention of recurrent stroke and had a higher risk of serious bleeding and death. Subgroup analysis showed that patients with the highest risk of recurrent stroke included those with 70% or more stenosis and/or recent symptoms and women. Angioplasty and stenting of intracranial stenosis have been undergoing rapid evolution in technology and are emerging as a promising therapy. Current treatment recommendations include antiplatelet agents, with consideration for angioplasty alone or angioplasty and stenting in cases refractory to medical therapy.

Safety and short-term results of stent-assisted angioplasty for the treatment of intracranial arterial stenosis

To evaluate the safety and short-term outcome of endovascular stent-assisted angioplasty for the treatment of intracranial arterial stenosis. Angioplasty and stent placement were administered to treat 46 patients with lesions of atherosclerotic intracranial stenosis, including 16 lesions of basilar artery, 12 of vertebral artery, 13 of internal carotid artery and 9 of middle cerebral artery. Technical success was achieved in 49 of 50 vessels (98%), with no procedure-related death or cerebral ischemic attack. Extracranial internal carotid artery dissection occurred in 1 patient and was successfully treated with a self-expand stent. One patient had subarachnoid hemorrhage because of perforation by microwire with no permanent neurologic deficit, and another 2 patients had groin hematoma. Angiographic examination immediately after stenting revealed that the stenosis rate was significantly reduced (72.4% +/- 12.3% vs 10.6% +/- 7.8%). There was no cerebral ischemic attack in the 37 patients who were clinically followed up (6 - 18 months, mean of 8.5 months). Angioplasty and stenting for the treatment of intracranial stenosis is safe and feasible, and it may be favorable for decreasing the incidence of ischemic attack.

頭蓋内動脈硬化性狭窄病変に対するｓｔｅｎｔ留置術−その有用性と問題点−

We report on 5 intracranial atherosclerotic stenoses treated with stent-assisted angioplasty. All lesions except for a stenosis that the stent was not able to access due to a severe tortuousity of the vessel were sufficiently and smoothly dilated with the use of a highly flexible, balloon-expandable coronary stent. All symptoms caused by the stenoses disappeared or diminished after the treatment. No complications occurred during or after the procedure. Follow-up angiograms obtained 6 months after the stenting showed no remarkable restenosis. This therapeutic option is a useful treatment for intracranial artery stenosis although further study, including clinical long-term follow-up, is necessary.