Endovascular Stenting for Symptomatic Atherosclerotic Stenosis of the Anterior and Posterior Cerebral Arteries: A Case Series

Lei WangZhiyong Zhang^*

• Beijing Geriatric Hospital, Beijing, China

Background: Symptomatic intracranial atherosclerotic stenosis (sICAS) in the anterior cerebral artery (ACA) or posterior cerebral artery (PCA) may result in disability even with the best pharmacological intervention. There is a paucity of evidence regarding endovascular procedures for sICAS associated with ACA or PCA. Methods: From January 2022 to December 2024, 12 patients with medically refractory sICAS associated with ACA or PCA, who received percutaneous transluminal angioplasty and stenting (PTAS), were included for analysis. Exclusion criteria included (1) non-atherosclerotic stenosis, concomitant infarcts in other vascular territories, antiplatelet contraindication, a baseline modified Rankin Scale (mRS) score of 3 or above, and (2) concomitant disease with survival < 2 years. sICAS with 70% to 99% stenosis and 2 or more strokes in the same vascular territory, with at least 1 stroke occurring during medical therapy, is considered refractory to medical treatment. Clinical data from these patients were collected and analyzed. Results: In 12 patients, 3 stenotic lesions were in the A2 segment of the ACA, and 9 were in the P1 or P2 segments of the PCA (stenosis > 70%). All lesions were treated with percutaneous transluminal angioplasty and stenting (1 with the NOVA intracranial sirolimus-eluting stent system, 1 with the Neuroform EZ stent, and 10 with the Neuroform Atlas stents), achieving a 100% technical success rate (residual stenosis < 30%). Dissection with unrestricted flow occurred in 1 patient (1/12) during stent placement, which disappeared 12 months later. The follow-up time ranged from 3 to 18 months (≥ 6 months in 11 patients). In the follow-up, 1 patient suffered a recurrent stroke (8.3%, 95% CI: 0.21-38.5%) due to the cessation of antiplatelet and anticoagulant medication 2 months after endovascular stenting; however, the remaining 11 patients exhibited a fair outcome with a modified Rankin Scale of 1 or 0 (91.67%, 95% CI: 61.5-99.8%) and no in-stent stenosis (0%, 95% CI: 0-26.5%). Conclusions: Endovascular stenting with newer self-expanding stents may be feasible and procedurally safe for patients with medically refractory sICAS associated with ACA or PCA. However, this therapy should not be treated as generalizable or low-risk. Further research is necessary for these patients.