ABSTRACT
In 1964, the father of interventional radiology Charles T. Dotter introduced the concept of transluminal angioplasty at the University of Oregon in Portland, United States, and applied it to the peripheral vascular system. At that time, he had already discussed its potential use for the renal and coronary circulation. However, his idea was ignored in the United States for nearly 15 years. The German-born cardiologist Andreas R. Gruentzig, who was introduced to angioplasty by Eberhart Zeitler, performed the first successful balloon angioplasty on human coronary artery in 1977 in Zurich, Switzerland. Since then percutaneous transluminal angioplasty (PTA) has rapidly evolved as a safe endovascular revascularization procedure for vascular occlusive diseases of the peripheral, renal, and coronary vascular system. In newer endovascular technologies, PTA is being replaced by primary stenting. Developments in microguidewire and balloon catheter technology have enabled the interventionalists to expand their experience gradually from the cervical parts of the carotid and vertebral arteries to the cerebrovascular circulation for treatment of symptomatic and medically refractory focal stenosis. Until recently, the introduction of stent technology to the anterior and posterior intracranial vascular systems has been limited by the lack of specific stents and delivery systems capable of safe, easy, and effective navigation through the neurovascular system. The advent of a new generation of more flexible stents and flexible delivery systems has prompted consideration of stentassisted angioplasty as an alternative approach in intracranial stenoses (1-5). In addition, recent advances in imaging, including 3D angiography, high-resolution and high-speed angiography, zoom digital fluoroscopy, biplane road mapping, and 3D road map, provide a precise and safe deployment of bioimplants. Although limited experience exists, short-and midterm angiographic and follow-up studies are encouraging. In this chapter, the rationale and indications as well as the technical aspects of endovascular revascularization for intracranial atherosclerotic occlusive disease (ICD) are presented.
