intracranial arteriosclerosis

Summary

Summary: Vascular diseases characterized by thickening and hardening of the walls of ARTERIES inside the SKULL. There are three subtypes: (1) atherosclerosis with fatty deposits in the ARTERIAL INTIMA; (2) Monckeberg's sclerosis with calcium deposits in the media and (3) arteriolosclerosis involving the small caliber arteries. Clinical signs include HEADACHE; CONFUSION; transient blindness (AMAUROSIS FUGAX); speech impairment; and HEMIPARESIS.

Top Publications

  1. Jiang W, Yu W, Du B, Gao F, Cui L. Outcome of patients with ?70% symptomatic intracranial stenosis after Wingspan stenting. Stroke. 2011;42:1971-5 pubmed publisher
    ..A randomized trial comparing medical therapy alone with medical therapy plus Wingspan stenting, conducted at high-volume centers, is needed to confirm the stenting benefit. ..
  2. Jin M, Fu X, Wei Y, Du B, Xu X, Jiang W. Higher risk of recurrent ischemic events in patients with intracranial in-stent restenosis. Stroke. 2013;44:2990-4 pubmed publisher
    ..01). In-stent restenosis after stenting of intracranial atherosclerosis is significantly associated with an increased risk and an earlier occurrence of recurrent ischemic events in the territory of the stented intracranial artery. ..
  3. Fiorella D, Turk A, Levy E, Pride G, Woo H, Albuquerque F, et al. U.S. Wingspan Registry: 12-month follow-up results. Stroke. 2011;42:1976-81 pubmed publisher
    ..Most of these ischemic events occurred within 6 months of the procedure and were associated with the interruption of antiplatelet therapy or in-stent restenosis. ..
  4. Choi J, Kim J, Choi B, Lim H, Kim S, Kim J, et al. Angiographic pattern of symptomatic severe M1 stenosis: comparison with presenting symptoms, infarct patterns, perfusion status, and outcome after recanalization. Cerebrovasc Dis. 2010;29:297-303 pubmed publisher
    ..Differences in patterns may be related to variation in collateral circulation at the ACA-MCA borderzone and hypoperfusion status. ..
  5. Rohde S, Seckinger J, Hahnel S, Ringleb P, Bendszus M, Hartmann M. Stent design lowers angiographic but not clinical adverse events in stenting of symptomatic intracranial stenosis - results of a single center study with 100 consecutive patients. Int J Stroke. 2013;8:87-94 pubmed publisher
    ..Thus, further development of intracranial stent systems and careful patient selection are mandatory. ..
  6. Vajda Z, Aguilar M, Göhringer T, Horvath Rizea D, Bazner H, Henkes H. Treatment of intracranial atherosclerotic disease with a balloon-expandable paclitaxel eluting stent: procedural safety, efficacy and mid-term patency. Clin Neuroradiol. 2012;22:227-33 pubmed publisher
    ..Application of the more flexible, newest generation thin-strut stents, however, shows promising results. ..
  7. Qureshi A, Al Senani F, Husain S, Janjua N, Lanzino G, Lavados P, et al. Intracranial angioplasty and stent placement after stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS) trial: present state and future considerations. J Neuroimaging. 2012;22:1-13 pubmed publisher
    ..There are potential patients in whom angioplasty and/or stent placement might be the best approach, and a new trial with appropriate modifications in patient selection and design may be warranted. ..
  8. Marks M. Is there a future for endovascular treatment of intracranial atherosclerotic disease after Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis (SAMMPRIS)?. Stroke. 2012;43:580-4 pubmed publisher
    ..This article explores possible reasons for these outcomes and discusses some weaknesses of the trial. Against this background endovascular therapy should continue to be explored in the treatment of this disease. ..
  9. Yu S, Leung T, Hung E, Lee K, Wong L. Angioplasty and stenting for intracranial atherosclerotic stenosis with nitinol stent: factors affecting technical success and patient safety. Neurosurgery. 2012;70:104-13 pubmed publisher
    ..Procedure-related factors could be identified and lead to improvements in patient safety and technical outcome. Tortuous vascular morphology is a key factor to be overcome. ..

More Information

Publications62

  1. Wong L. Global burden of intracranial atherosclerosis. Int J Stroke. 2006;1:158-9 pubmed publisher
  2. Masuoka T, Hayashi N, Hori E, Kuwayama N, Ohtani O, Endo S. Distribution of internal elastic lamina and external elastic lamina in the internal carotid artery: possible relationship with atherosclerosis. Neurol Med Chir (Tokyo). 2010;50:179-82 pubmed
    ..Change in the elasticity of the arterial wall in the cavernous portion may be an important factor in the process of atherosclerosis in the intracranial ICA...
  3. Jiang W, Cheng Ching E, Abou Chebl A, Zaidat O, Jovin T, Kalia J, et al. Multicenter analysis of stenting in symptomatic intracranial atherosclerosis. Neurosurgery. 2012;70:25-30; discussion 31 pubmed publisher
    ..Less posttreatment stenosis was associated with lower rates of mid-term restenosis. Future randomized trials comparing BESs and SESs may help to identify the stent type that is safest and most durable. ..
  4. Li J, Zhao Z, Gao G, Deng J, Yu J, Gao L, et al. Wingspan stent for high-grade symptomatic vertebrobasilar artery atherosclerotic stenosis. Cardiovasc Intervent Radiol. 2012;35:268-78 pubmed publisher
    ..This study was designed to present the treatment outcomes with Wingspan stent angioplasty of high-grade intracranial vertebrobasilar artery (VBA) stenosis in symptomatic patients...
  5. Zhang L, Huang Q, Zhang Y, Liu J, Hong B, Xu Y, et al. Wingspan stents for the treatment of symptomatic atherosclerotic stenosis in small intracranial vessels: safety and efficacy evaluation. AJNR Am J Neuroradiol. 2012;33:343-7 pubmed publisher
    ..The ISR rate was relatively high; most patients having ISR were asymptomatic. Further follow-up is needed to assess the long-term efficacy of this procedure. ..
  6. Yu J, Wang L, Deng J, Gao L, Zhang T, Zhao Z, et al. Treatment of symptomatic intracranial atherosclerotic stenosis with a normal-sized Gateway(™) balloon and Wingspan(™) stent. J Int Med Res. 2010;38:1968-74 pubmed
    ..0%) than in group U (33.3%). It is concluded that use of a normal-sized Gateway(™) balloon and Wingspan(™) stent appears to be safe, to have a high rate of technical success, good immediate post-operative results and a low ISR rate. ..
  7. Vajda Z, Schmid E, Güthe T, Klotzsch C, Lindner A, Niehaus L, et al. The modified Bose method for the endovascular treatment of intracranial atherosclerotic arterial stenoses using the Enterprise stent. Neurosurgery. 2012;70:91-101; discussion 101 pubmed publisher
    ..Follow-up results were equal to or better than those reported for bare-metal balloon-expandable or self-expanding stents and yielded excellent protection from recurrent ischemia. ..
  8. Yu S, Leung T, Lee K, Hui J, Wong L. Angioplasty and stenting of atherosclerotic middle cerebral arteries with Wingspan: evaluation of clinical outcome, restenosis, and procedure outcome. AJNR Am J Neuroradiol. 2011;32:753-8 pubmed publisher
    ..9% versus 0%. In this study, there were no significant differences in procedural safety, patient outcome, and restenosis rates of stent placement between the group with MCA stenosis and the group with stenoses located at other sites. ..
  9. Erbay S, O Callaghan M, Shah P, Kini J, Bassett Midle J, Polak J. Prospective evaluation of the role of atherosclerosis on cerebral atrophy: pilot study. J Neuroimaging. 2008;18:375-80 pubmed publisher
    ..41). However, this correlation did not reach a statistically significant level (P= .10). Intracranial atherosclerosis demonstrated a possible correlation with central atrophy. ..
  10. Rincon F, Sacco R, Kranwinkel G, Xu Q, Paik M, Boden Albala B, et al. Incidence and risk factors of intracranial atherosclerotic stroke: the Northern Manhattan Stroke Study. Cerebrovasc Dis. 2009;28:65-71 pubmed publisher
    ..6; 95% CI, 1.1-18.7) when compared to EATH (OR, 2.3; CI, 0.6-9.1) and NATH (OR, 2.4; CI, 1.7-3.3). DM is a more important determinant for IATH-related stroke than EATH or NATH. ..
  11. Chimowitz M, Lynn M, Derdeyn C, Turan T, Fiorella D, Lane B, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365:993-1003 pubmed publisher
    ..Funded by the National Institute of Neurological Disorders and Stroke and others; SAMMPRIS ClinicalTrials.gov number, NCT00576693.). ..
  12. Dumont T, Kan P, Snyder K, Hopkins L, Siddiqui A, Levy E. Revisiting angioplasty without stenting for symptomatic intracranial atherosclerotic stenosis after the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS) study. Neurosurgery. 2012;71:1103-10 pubmed publisher
  13. Costalat V, Maldonado I, Vendrell J, Riquelme C, Machi P, Arteaga C, et al. Endovascular treatment of symptomatic intracranial stenosis with the Wingspan stent system and Gateway PTA balloon: a multicenter series of 60 patients with acute and midterm results. J Neurosurg. 2011;115:686-93 pubmed publisher
    ..Technical failure, residual stenosis, or in-stent restenosis did not lead to systematic recurrent stroke in this series, which suggests the importance of plaque stabilization and neoendothelialization. ..
  14. Kurre W, Brassel F, Bruning R, Buhk J, Eckert B, Horner S, et al. Complication rates using balloon-expandable and self-expanding stents for the treatment of intracranial atherosclerotic stenoses : analysis of the INTRASTENT multicentric registry. Neuroradiology. 2012;54:43-50 pubmed publisher
    ..There might be an advantage using self-expanding stents in vessel segments with important perforating arteries. ..
  15. Tarlov N, Jahan R, Saver J, Sayre J, Ali L, Kim D, et al. Treatment of high risk symptomatic intracranial atherosclerosis with balloon mounted coronary stents and Wingspan stents: single center experience over a 10 year period. J Neurointerv Surg. 2012;4:34-9 pubmed publisher
    ..Stenting of symptomatic intracranial atherosclerosis in a high risk subset of cases with advanced degree of luminal stenosis may be associated with an increased early risk of recurrent ischemic stroke. ..
  16. Hussain M, Fraser J, Abruzzo T, Blackham K, Bulsara K, Derdeyn C, et al. Standard of practice: endovascular treatment of intracranial atherosclerosis. J Neurointerv Surg. 2012;4:397-406 pubmed publisher
    ..Further studies are necessary to define appropriate patient selection and the best therapeutic approach for various subsets of patients. ..
  17. Man B, Fu Y, Chan Y, Lam W, Hui A, Leung W, et al. Lesion patterns and stroke mechanisms in concurrent atherosclerosis of intracranial and extracranial vessels. Stroke. 2009;40:3211-5 pubmed publisher
    ..The typical lesion patterns and the mechanisms of stroke in patients with concurrent stenoses are unclear. This study aimed to determine these stroke features of such patients in Hong Kong...
  18. Kim Y, Choi H, Jung Y, Nam C, Yang J, Cho H, et al. Mirror pattern of cerebral artery atherosclerosis in patients with ischaemic stroke. Eur J Neurol. 2009;16:1159-64 pubmed publisher
    ..In patients with cerebral artery atherosclerosis, the occurrence and progression of atherosclerosis in the contralateral cerebral artery should be considered during follow-up examination. ..
  19. Zhang L, Huang Q, Zhang Y, Deng B, Liu J, Hong B, et al. A single-center study of Wingspan stents for symptomatic atherosclerotic stenosis of the middle cerebral artery. J Clin Neurosci. 2013;20:362-6 pubmed publisher
    ..It may result in a good long-term benefit. Prospective randomized controlled trials and further long-term follow up are needed to provide more adequate statistical evidence to support our findings...
  20. Park J, Hong K, Lee E, Lee J, Kim D. High levels of apolipoprotein B/AI ratio are associated with intracranial atherosclerotic stenosis. Stroke. 2011;42:3040-6 pubmed publisher
    ..A higher apoB/apoAI ratio is a predictor of ICAS rather than of extracranial atherosclerotic stenosis or no cerebral atherosclerotic stenosis. The apoB/apoAI ratio might be a biomarker for ICAS in Asian patients with stroke. ..
  21. Vajda Z, Miloslavski E, Güthe T, Schmid E, Schul C, Albes G, et al. Treatment of intracranial atherosclerotic arterial stenoses with a balloon-expandable cobalt chromium stent (Coroflex Blue): procedural safety, efficacy, and midterm patency. Neuroradiology. 2010;52:645-51 pubmed publisher
    ..The Coroflex Blue stent is easily inserted and safely deployed into intracranial arteries. The incidence of recurrent stenoses remains a concern. Stringent angiographic and clinical follow-up and retreatment are therefore mandatory. ..
  22. Samaniego E, Hetzel S, Thirunarayanan S, Aagaard Kienitz B, Turk A, Levine R. Outcome of symptomatic intracranial atherosclerotic disease. Stroke. 2009;40:2983-7 pubmed publisher
    ..3%) events in the PTAS Group. Overall, the combined ischemic end point was the same in the Medical Therapy and PTAS Groups. ..
  23. Ryu C, Jahng G, Kim E, Choi W, Yang D. High resolution wall and lumen MRI of the middle cerebral arteries at 3 tesla. Cerebrovasc Dis. 2009;27:433-42 pubmed publisher
    ..High-resolution, multicontrast-weighted BB-MRI has the potential to characterize atherosclerotic plaques in the MCA and may be a useful modality for evaluating the degree of stenosis. ..
  24. Niizuma K, Shimizu H, Takada S, Tominaga T. Middle cerebral artery plaque imaging using 3-Tesla high-resolution MRI. J Clin Neurosci. 2008;15:1137-41 pubmed publisher
    ..Progression of symptoms occurred in the patients with plaques. We conclude that 3T HRT2WI can identify plaque on MCA walls and has the potential to identify patients at risk for stroke progression or recurrence. ..
  25. Lü P, Park J, Park S, Kim J, Lee D, Kwon S, et al. Intracranial stenting of subacute symptomatic atherosclerotic occlusion versus stenosis. Stroke. 2011;42:3470-6 pubmed publisher
    ..However, several factors, including age, tended to be associated with a higher event rate. ..
  26. Thijs V, Albers G. Symptomatic intracranial atherosclerosis: outcome of patients who fail antithrombotic therapy. Neurology. 2000;55:490-7 pubmed
    ..Recurrent ischemic events typically occur within a few months after failure of standard medical therapy. The high recurrence risk observed warrants testing of alternative treatment strategies such as intracranial angioplasty. ..
  27. Beach T, Wilson J, Sue L, Newell A, Poston M, Cisneros R, et al. Circle of Willis atherosclerosis: association with Alzheimer's disease, neuritic plaques and neurofibrillary tangles. Acta Neuropathol. 2007;113:13-21 pubmed
    ..The results suggest that the statistical association between intracranial atherosclerosis and AD is not an artifact of diagnostic misclassification or of unequal distribution of the apolipoprotein E-epsilon4 allele...
  28. Arenillas J, Alvarez Sabin J, Molina C, Chacon P, Fernandez Cadenas I, Ribo M, et al. Progression of symptomatic intracranial large artery atherosclerosis is associated with a proinflammatory state and impaired fibrinolysis. Stroke. 2008;39:1456-63 pubmed publisher
  29. Abou Chebl A, Bashir Q, Yadav J. Drug-eluting stents for the treatment of intracranial atherosclerosis: initial experience and midterm angiographic follow-up. Stroke. 2005;36:e165-8 pubmed
    ..Elective intracranial stenting with DES appears to be feasible and safe, but additional clinical experience is required to assess its efficacy. ..
  30. Wojak J, Dunlap D, Hargrave K, DeAlvare L, Culbertson H, Connors J. Intracranial angioplasty and stenting: long-term results from a single center. AJNR Am J Neuroradiol. 2006;27:1882-92 pubmed
    ..Intracranial angioplasty with conditional stent placement is technically feasible and clinically effective with a substantial reduction in long-term stroke and death. ..
  31. Hoshino A, Nakamura T, Enomoto S, Kawahito H, Kurata H, Nakahara Y, et al. Prevalence of coronary artery disease in Japanese patients with cerebral infarction: impact of metabolic syndrome and intracranial large artery atherosclerosis. Circ J. 2008;72:404-8 pubmed
    ..Both metabolic syndrome and intracranial large artery atherosclerosis may be potential predictors for identifying patients with cerebral infarction who are at the highest risk of asymptomatic CAD. ..
  32. Lopes D, Ringer A, Boulos A, Qureshi A, Lieber B, Guterman L, et al. Fate of branch arteries after intracranial stenting. Neurosurgery. 2003;52:1275-8; discussion 1278-9 pubmed
    ..The flexible, low-profile stents used in this study had no angiographically or clinically apparent effect on the major intracranial branches across which they were placed. ..
  33. Jiang W, Wang Y, Du B, Wang S, Wang G, Jin M, et al. Stenting of symptomatic M1 stenosis of middle cerebral artery: an initial experience of 40 patients. Stroke. 2004;35:1375-80 pubmed
    ..The LMA classification seems to be helpful to work out the individual therapy and predict the results of stenting. A further study is needed to confirm the benefits of stenting of MCA stenosis. ..
  34. Elkind M. Inflammation, atherosclerosis, and stroke. Neurologist. 2006;12:140-8 pubmed
    ..Modalities to reduce inflammation are becoming available that may help to modify this risk. Further studies, however, are needed before inflammatory markers become a routine part of the evaluation of stroke patients. ..
  35. D Armiento F, Bianchi A, de Nigris F, Capuzzi D, D Armiento M, Crimi G, et al. Age-related effects on atherogenesis and scavenger enzymes of intracranial and extracranial arteries in men without classic risk factors for atherosclerosis. Stroke. 2001;32:2472-9 pubmed
  36. Chimowitz M, Lynn M, Howlett Smith H, Stern B, Hertzberg V, Frankel M, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352:1305-16 pubmed
    ..48; P=0.83). Warfarin was associated with significantly higher rates of adverse events and provided no benefit over aspirin in this trial. Aspirin should be used in preference to warfarin for patients with intracranial arterial stenosis. ..
  37. Arenillas J, Candell Riera J, Romero Farina G, Molina C, Chacon P, Aguadé Bruix S, et al. Silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis: associated factors. Stroke. 2005;36:1201-6 pubmed
    ..Stenosed intracranial ICA, symptomatic vertebrobasilar stenosis and presence of high Lp(a) and Hcy levels may characterize the patients at a higher risk for occult CAD. ..
  38. Qureshi A, Kirmani J, Hussein H, Harris Lane P, Divani A, Suri M, et al. Early and intermediate-term outcomes with drug-eluting stents in high-risk patients with symptomatic intracranial stenosis. Neurosurgery. 2006;59:1044-51; discussion 1051 pubmed
    ..One symptomatic angiographic restenosis was observed during the follow-up period. A low rate of major stroke or death was observed after treatment of symptomatic intracranial stenosis using drug-eluting stents in high-risk patients. ..
  39. Wong K, Huang Y, Yang H, Gao S, Li H, Liu J, et al. A door-to-door survey of intracranial atherosclerosis in Liangbei County, China. Neurology. 2007;68:2031-4 pubmed
    ..53; 95% CI 1.12 to 5.72), glycosuria (OR 3; 1.19 to 7.97), heart disease (OR 4; 1.39 to 11.6), and family history of stroke (OR 5.2; 1.38 to 20). Intracranial atherosclerosis is not uncommon among asymptomatic Chinese subjects. ..
  40. Marks M, Wojak J, Al Ali F, Jayaraman M, Marcellus M, Connors J, et al. Angioplasty for symptomatic intracranial stenosis: clinical outcome. Stroke. 2006;37:1016-20 pubmed
    ..Long-term clinical follow-up of intracranial angioplasty patients demonstrates a risk of future strokes that compares favorably to patients receiving medical therapy. ..
  41. Wong K, Ng P, Tang A, Liu R, Yeung V, Tomlinson B. Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients. Neurology. 2007;68:2035-8 pubmed
    ..The prevalence escalated quadratically with increasing number of associated factors: from 7.2% for one, to 29.6% for four associated factors. Asymptomatic middle cerebral artery stenosis is common in patients with vascular risk factors. ..
  42. Derdeyn C, Chimowitz M. Angioplasty and stenting for atherosclerotic intracranial stenosis: rationale for a randomized clinical trial. Neuroimaging Clin N Am. 2007;17:355-63, viii-ix pubmed
    ..This article reviews these data and discusses the rationale for a randomized trial of angioplasty and stenting versus best medical management for patients who have symptomatic intracranial stenosis. ..
  43. Gupta R, Schumacher H, Mangla S, Meyers P, Duong H, Khandji A, et al. Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis. Neurology. 2003;61:1729-35 pubmed
    ..The results suggest that patient selection, procedure timing, and periprocedural medical management are critical factors to reduce periprocedural morbidity and mortality. ..
  44. Lee S, Cho S, Moon H, Shon Y, Lee K, Kim D, et al. Combined extracranial and intracranial atherosclerosis in Korean patients. Arch Neurol. 2003;60:1561-4 pubmed
    ..Diabetes mellitus is associated with intracranial atherosclerosis in patients who had steno-occlusive extracranial carotid artery disease. ..
  45. Turk A, Levy E, Albuquerque F, Pride G, Woo H, Welch B, et al. Influence of patient age and stenosis location on wingspan in-stent restenosis. AJNR Am J Neuroradiol. 2008;29:23-7 pubmed
  46. Higashida R, Meyers P. Intracranial angioplasty and stenting for cerebral atherosclerosis: new treatments for stroke are needed!. Neuroradiology. 2006;48:367-72 pubmed
    ..Ultimately, determination of which patients should undergo revascularization procedures will require carefully planned, randomized clinical trials. ..
  47. Bang O, Kim J, Lee J, Lee M, Lee P, Joo I, et al. Association of the metabolic syndrome with intracranial atherosclerotic stroke. Neurology. 2005;65:296-8 pubmed
    ..005). The results suggest that treatment of metabolic abnormalities may be an important prevention strategy for intracranial atherosclerosis. ..
  48. Levy E, Hanel R, Boulos A, Bendok B, Kim S, Gibbons K, et al. Comparison of periprocedure complications resulting from direct stent placement compared with those due to conventional and staged stent placement in the basilar artery. J Neurosurg. 2003;99:653-60 pubmed
    ..Although direct stent placement in peripheral and coronary vessels has been shown to be safe, the authors suggest that direct stent placement in the BA should be avoided to minimize the risk of periprocedure morbidity. ..
  49. Wong K, Li H. Long-term mortality and recurrent stroke risk among Chinese stroke patients with predominant intracranial atherosclerosis. Stroke. 2003;34:2361-6 pubmed
    ..Our findings provide important data for planning future randomized clinical trials for this high-risk group of stroke patients. ..
  50. Suh D, Kim J, Choi J, Choi B, Pyun H, Choi Y, et al. Intracranial stenting of severe symptomatic intracranial stenosis: results of 100 consecutive patients. AJNR Am J Neuroradiol. 2008;29:781-5 pubmed publisher
    ..167; 95% CI, 1.933-34.500; P = .004). BEICS revealed a low AE and good outcome rate at 6 months, especially in the stable patients. Midterm outcome was also favorable in the unstable patient group. ..
  51. Fiorella D, Levy E, Turk A, Albuquerque F, Niemann D, Aagaard Kienitz B, et al. US multicenter experience with the wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results. Stroke. 2007;38:881-7 pubmed
    ..Our initial experience indicates that this procedure represents a viable treatment option for this patient population. ..
  52. Arenillas J, Molina C, Chacon P, Rovira A, Montaner J, Coscojuela P, et al. High lipoprotein (a), diabetes, and the extent of symptomatic intracranial atherosclerosis. Neurology. 2004;63:27-32 pubmed
    ..These findings support a role for Lp(a) in intracranial stenotic atherogenesis and might be useful for the selection of high-risk patients. ..
  53. de Rochemont R, Turowski B, Buchkremer M, Sitzer M, Zanella F, Berkefeld J. Recurrent symptomatic high-grade intracranial stenoses: safety and efficacy of undersized stents--initial experience. Radiology. 2004;231:45-9 pubmed
    ..In selected patients with recurrent ischemic events due to high-grade intracranial stenosis, undersized stent placement holds promise as an effective and safe procedure. ..