Long-term clinical and angiographic outcome from angioplasty and stenting for intracranial stenosis

2022 ◽  
Author(s):  
Sang Kyu Park ◽  
Sang Hyun Suh ◽  
Kyeong Sool Jang ◽  
Dong Kyu Jang ◽  
Dong Young Jo ◽  
...  
Keyword(s):  
Intracranial Stenosis ◽  
Angioplasty And Stenting

Periprocedural risk and long-term outcome of intracranial angioplasty based on a single-centre experience

VASA ◽  
2013 ◽  
Vol 42 (4) ◽  
pp. 264-274
Author(s):  
Dagmar Krajíčková ◽  
Antonín Krajina ◽  
Miroslav Lojík ◽  
Martina Mulačová ◽  
Martin Vališ
Keyword(s):  
Death Rate ◽  
Long Term Outcomes ◽  
Single Centre ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Angioplasty And Stenting ◽  
Aggressive Medical Management ◽  
Stroke Death

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

Endovascular Treatment of Iliac Occlusive Disease: Review and Update

Vascular ◽  
2007 ◽  
Vol 15 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Albeir Y. Mousa ◽  
Robert B. Beauford ◽  
Lucio Flores ◽  
Peter L. Faries ◽  
Prem Patel ◽  
...  
Keyword(s):  
Transluminal Angioplasty ◽  
Occlusive Disease ◽  
Success Rates ◽  
Endovascular Interventions ◽  
Late Failure ◽  
Therapeutic Measures ◽  
Comparison Of Techniques ◽  
Open Versus ◽  
Angioplasty And Stenting

Use of endovascular interventions for arterial occlusive lesions continues to increase. With the evolution of the technology supporting these therapeutic measures, the results of these interventions continue to improve. In general, a comparison of techniques for revascularization of iliac occlusive diseases shows similar initial technical success rates for open versus percutaneous transluminal angioplasty. Angioplasty is often associated with lower periprocedural morbidity and mortality rates. Conversely, surgery frequently provides greater long-term patency, although late failure of percutaneous therapies may occur but still can be treated successfully with reintervention. The perpetual buildup of experience with angioplasty and stenting will eventually characterize its role in the management of occlusive disease. This review outlines the current consensus and applicability of endovascular management of iliac occlusive diseases.

Abstract 81: Recurrent Stroke Risk After Angioplasty and Stenting for Symptomatic Intracranial Stenosis: Data From the SAMMPRIS Trial

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Colin Derdeyn ◽  
David Fiorella ◽  
Tanya Turan ◽  
Jean Montgomery ◽  
Bethany Lane ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Primary Endpoint ◽  
Imaging Modality ◽  
Recurrent Stroke ◽  
Intracranial Stenosis ◽  
Stent Restenosis ◽  
Primary Endpoints ◽  
Angioplasty And Stenting ◽  
In Stent Restenosis

Purpose: To investigate the incidence and clinical characteristics of recurrent stroke beyond 30 days after uncomplicated angioplasty and stenting for symptomatic intracranial stenosis. Methods: Primary endpoints in SAMMPRIS (Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke) after 30 days past enrollment were defined as ischemic stroke in the territory or any stroke or death within 30 days of a subsequent revascularization procedure. Endpoints were independently and blindly adjudicated. Study records and imaging studies of subjects randomized to the stent arm with post-30 day primary endpoints were reviewed. Instent restenosis (ISR) was categorized as severe (>70%), moderate (50-69%) or mild (< 50%) based on consensus of two reviewers. Findings were categorized as definite, probable, or indeterminate based on imaging modality and study quality. Results: 224 subjects were randomized to the stent arm and 33 suffered a primary endpoint within 30 days of enrollment. Nineteen of the remaining 191 subjects (9.9%) suffered a primary endpoint during follow up (median follow up of 32.4 months). Eighteen had an ischemic stroke in the territory and one had a symptomatic intracranial hemorrhage after repeat angioplasty for in stent restenosis (ISR). In the 18 patients with ischemic stroke, the vascular imaging findings were: complete stent occlusion in 2 (1 of these was acutely revascularized and severe underlying ISR was identified), severe ISR by catheter angiography in 5, severe ISR or occlusion by computed tomographic angiography (CTA) in 1, probable ISR by CTA or magnetic resonance angiography (MRA) in 3, moderate stenosis on angiography in 2 (1 with ISR and 1 with a residual stenosis), indeterminate in 2, normal in 2, and not done in 1. Lesion locations included: distal internal carotid (6), petrous carotid (1), basilar (5), middle cerebral (6), and vertebral (1) arteries. Median time to recurrent stroke was 7.7 months from enrollment (2.2 to 28.2 months). Conclusions: The incidence of recurrent stroke beyond 30 days after uncomplicated angioplasty and stenting in the SAMMPRIS trial was nearly 10% over a mean follow-up of almost 3 years. In stent restenosis was associated with the majority of recurrent strokes.

Long-term Results of Angioplasty and Stenting for Radiation Induced Carotid Stenoses

2018 ◽  
Vol 53 ◽  
pp. 34
Author(s):  
Bahaa Nasr ◽  
Edouard Penasse ◽  
Eugenio Rosset ◽  
Patrick Feugier ◽  
Yann Gouëffic ◽  
...  
Keyword(s):  
Long Term Results ◽  
Carotid Stenoses ◽  
Radiation Induced ◽  
Angioplasty And Stenting

Current Concepts in the Management of Intracranial Atherosclerotic Disease

Neurosurgery ◽  
2006 ◽  
Vol 59 (suppl_5) ◽  
pp. S210-S218 ◽  
Author(s):  
Robert D. Ecker ◽  
Elad I. Levy ◽  
Eric Sauvageau ◽  
Ricardo A. Hanel ◽  
L Nelson Hopkins
Keyword(s):  
Endovascular Treatment ◽  
Poor Prognosis ◽  
Intracranial Stenosis ◽  
Atherosclerotic Disease ◽  
Intracranial Atherosclerosis ◽  
Intracranial Atherosclerotic Disease ◽  
New Models ◽  
Disease Study ◽  
Angioplasty And Stenting ◽  
Neuroimaging Techniques

Abstract MEDICALLY REFRACTORY, SYMPTOMATIC intracranial atherosclerotic disease has a poor prognosis. Based on the results of the Warfarin-Aspirin Symptomatic Intracranial Disease study, the risk of ipsilateral stroke at 1.8 years is between 13 and 14% in patients with symptomatic intracranial atherosclerosis. Synergistic advances in intracranial angioplasty and stenting, modern neuroimaging techniques, and periprocedural and postprocedural antithrombotic regimens are creating new models for the diagnosis and successful endovascular treatment of intracranial stenosis. In this article, the most recent clinical developments and concepts for the diagnosis and endovascular treatment of intracranial atherosclerotic disease are discussed.

Long-Term Evolutionary Change in the Lumen of Intracranial Atherosclerotic Stenosis Following Angioplasty and Stenting

2017 ◽  
Vol 14 (2) ◽  
pp. 128-138 ◽  
Author(s):  
Simon C H Yu ◽  
Tiffany W W Lau ◽  
Simon S M Wong ◽  
Kwok T Lee ◽  
Lawrence K S Wong ◽  
...  
Keyword(s):  
Intracranial Atherosclerosis ◽  
Medical Group ◽  
Intravenous Contrast ◽  
Arterial Lumen ◽  
Atherosclerotic Stenosis ◽  
Patient Consent ◽  
Significant Difference ◽  
Angioplasty And Stenting ◽  
Ischemic Events

Abstract BACKGROUND Angioplasty and stenting is a recognized treatment option for patients with intracranial atherosclerosis. OBJECTIVE To evaluate the long-term evolutionary luminal changes of intracranial atherosclerosis after angioplasty and stenting. METHODS This was a retrospective study with patient consent. Eighty-two patients presenting with acute and minor cerebral ischemia due to stenosis ≥70%, who had received medical therapy with or without stenting (Wingspan), were invited. Luminal imaging was provided using 3-dimensional rotational angiography (3-DRA) at baseline and 12 mo, and cone-beam computed tomography angiography with intravenous contrast (CBCT) was provided at follow-up (median 82.4 mo [interquartile range 61.9-96.9 mo]). RESULTS Thirty-six patients in the stenting group and 26 patients in the medical group were recruited and completed the study. There was no statistically significant difference in demographics between the 2 patient groups. The luminal gain at 12 or 80 mo as compared to baseline in the stenting group was significantly greater than that in the medical group (12 mo: median gain 30% vs 7.2%, P &lt; .001; 80 mo: median gain 42.9% vs 7.2%, P &lt; .0001). Luminal loss or unchanged lumen was correlated with recurrent ischemic event. The differences in the stenosis degree assessment between CBCT and 3-DRA in the same 10 patients with or without stenting were 1.2 ± 0.6% or 0.2 ± 0.06%, respectively. There was a correlation between recurrent ischemic events and luminal loss. CONCLUSION Arterial lumen after angioplasty and stenting can probably be well maintained and delayed luminal gain does occur, long-term luminal loss is associated with recurrent ischemic events, CBCT might be useful as a less-invasive means for long-term assessment.

Ischaemic Stroke - Stenting versus Surgery for Carotid Disease

2012 ◽  
Vol 7 (1) ◽  
pp. 41 ◽  
Author(s):  
Swaroop Pawar ◽  
Steven R Messé ◽  
◽  
Keyword(s):  
Patient Characteristics ◽  
Internal Carotid Artery Stenosis ◽  
Bleeding Complications ◽  
Severe Stenosis ◽  
Cranial Nerve Injury ◽  
Endovascular Approach ◽  
Ischaemic Attack ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Extracranial internal carotid artery stenosis is one of the most common and best studied causes of stroke. Revascularisation with carotid endarterectomy (CEA) has been shown to be beneficial for patients with severe stenosis associated with stroke or transient ischaemic attack (TIA) and for many patients with moderate stenosis associated with stroke or TIA. CEA has also been shown to be beneficial for patients with asymptomatic severe stenosis if they have a reasonable expected lifespan and surgical risk, but the benefit is greater for men compared with women. Carotid angioplasty and stenting (CAS) has become a viable alternative procedure for carotid revascularisation with less risk of major bleeding complications and cranial nerve injury. Randomised studies of CEA versus CAS have found that the endovascular approach is associated with a lower risk of myocardial infarction but a higher risk of peri-procedural stroke which has a greater impact on long-term quality of life. Thus, recommending CEA or CAS must be based upon individual patient characteristics and their preferences, but at this point it appears that most patients should still be receiving CEA if an intervention is required.

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