Table 1.
Summary of Seven Endovascular Treatments Performed for Refractory Giant Cell Arteritis with Intracranial Stenosis
| Endovascular treatments in medically refractory intracranial giant cell arteritis in a single patient | |||||||
|---|---|---|---|---|---|---|---|
| Treatment number (date from start of medical therapy) | |||||||
| 1 (Day 28) |
2 (Day 38) |
3 (Day 48) |
4 (Day 49) |
5 (Day 67) |
6 (Day 80) |
7 (Day 136) |
|
| Indication for treatment |
LICA/ACA watershed stroke DWI |
Pontine Stroke DWI, prolonged CTP Tmax |
Pressure-dependent LLE weakness, prolonged CTP Tmax | RLE weakness |
New left ACA/ICA watershed infarct DWI, BLE weakness |
New cerebellar infarct DWI | New left basal ganglia infarct DWI, decreased right sided movement |
| Target vessel(s) | LICA (PTA + CCB) | LVA (PTA + CCB) | LICA (PTA + CCB), RICA (CCB) | RICA (PTA + CCB) |
LICA, supraclinoid (PTA + CCB) LICA, petrous (PTA + CCB) |
LVA (PTA + CCB) |
LICA (PTA) |
| Devices |
2.0 × 15 mm Gateway Balloon |
2.0 × 15 mm Gateway Balloon |
2.25 × 15 mm Gateway Balloon |
2.5 × 15 mm Gateway Balloon |
3.0 × 15 mm (petrous) and 2.5 × 9 mm Gateway Balloon (supraclinoid) | 2.0 × 15 mm Gateway Balloon |
3 × 20 mm and 2.25 × 20 mm Gateway Balloon |
| Verapamil | 5 mg, LICA | 10 mg, LVA |
20 mg, RICA 15 mg, LICA |
10 mg, RICA | 10 mg, LICA | 20 mg, LVA | None |
| Complications | Non-flow limiting dissection | – | – | – | AICH | – | AICH |
| Angiographic result | > 90% → 50% stenosis | LVA 90% → 50% |
RICA: 80% → 60% LICA: > 90% → 60% |
RICA 90% → 30% |
LICA petrous > 90% → 20% LICA supraclinoid 90% → 40% |
LVA 2 sites, both 80–90% → 20% | LICA > 90% → 20% |
| Treatment durabilitya | – | LICA: durable |
LVA: durable LICA: restenosis RICA: progression |
RICA: restenosis LICA: durable LVA: durable |
Petrous LICA: new stenosis supraclinoid LICA: restenosis RICA: durable LVA: durable |
LVA: restenosis RICA: durable LICA: durable |
LICA restenosis LVA: durable RICA: durable |
AICH asymptomatic intracranial hemorrhage, LICA left internal carotid artery, RICA right internal carotid artery, ACA anterior cerebral artery, PTA percutaneous transluminal angioplasty, LVA lift vertebral artery, CCB calcium channel blocker, LLE left leg, RLE right leg, BLE both leg, DWI diffusion weighted imaging
aDefined by luminal diameter on subsequent DSA compared with immediate prior DSA