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.

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

2020 ◽  
Vol 12 (11) ◽  
pp. 1127-1131
Author(s):  
Lukas Meyer ◽  
Hannes Leischner ◽  
Goetz Thomalla ◽  
Lars Udo Krause ◽  
Stephan Lowens ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Stroke Prevention ◽  
Balloon Catheter ◽  
Intracranial Stenosis ◽  
Secondary Stroke Prevention ◽  
Stent Patency ◽  
Fatal Stroke ◽  
Stent Restenosis ◽  
In Stent Restenosis

Background and purposeStroke recurrence is high in patients with symptomatic intracranial stenosis despite best medical treatment. Based on evidence from past studies using previous stent generations, elective intracranial stenting (eICS) is considered in a minority of patients. This study aims to report on experience performing eICS with a novel device combination.MethodsWe retrospectively reviewed data from three high volume stroke centers and analyzed patients that were treated with eICS for symptomatic intracranial stenosis using the Acclino (flex) stent and the NeuroSpeed balloon catheter (Acandis GmbH, Pforzheim, Germany). Study endpoints were periprocedural rates of stroke regardless of territory or death at discharge and at the time of follow-up after eICS. Safety evaluation included asymptomatic and symptomatic intracranial hemorrhage, serious adverse events related to the intervention, and evaluation of stent patency at the time of follow-up.ResultsThe median age of patients that met the inclusion criteria (n=76) was 69 years. Target vessels were located in the anterior circulation in 55.3% (42/76) of patients. The periprocedural stroke rate was 6.5% (fatal stroke 2.6%; non-fatal stroke 3.9%) at discharge after eICS. Asymptomatic intracranial hemorrhage was observed in 5.2% (4/76) of patients. Follow-up DSA revealed in-stent restenosis of 25% (15/60), and percutaneous transluminal angioplasty was performed again in 11.6% (7/60) of patients.ConclusionStenting for symptomatic intracranial stenosis with the Acclino (flex)/NeuroSpeed balloon catheter seemed to be safe and reinforces eICS as an endovascular therapy option for secondary stroke prevention. Future studies are warranted to confirm these findings and investigate antithrombotic strategies and in-stent restenosis to minimize periprocedural complications and guarantee long term stent patency.

The myth of restenosis after carotid angioplasty and stenting

2015 ◽  
Vol 8 (10) ◽  
pp. 1006-1010 ◽  
Author(s):  
Karam Moon ◽  
Felipe C Albuquerque ◽  
Michael R Levitt ◽  
Azam S Ahmed ◽  
M Yashar S Kalani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neck Surgery ◽  
Stent Restenosis ◽  
Atherosclerotic Lesions ◽  
Hostile Neck ◽  
History Of ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting ◽  
In Stent Restenosis

Background and purposeReported rates of in-stent restenosis after carotid artery stenting (CAS) vary, and restenosis risk factors are poorly understood. We evaluated restenosis rates and risk factors, and compared patients with ‘hostile-neck’ carotids (a history of ipsilateral neck surgery or irradiation) and atherosclerotic lesions.MethodsDemographic, clinical, and radiological characteristics of patients undergoing cervical CAS between 1995 and 2010 with at least 1 month of follow-up were reviewed. Patients with substantial (≥50%) radiographic restenosis were compared with those without significant restenosis to identify restenosis risk factors.ResultsThe analysis included 121 patients with 133 stented vessels; 91 (68.4%) lesions were symptomatic. Indications for stent placement included hostile-neck lesions, substantial surgical comorbidities, inclusion in a randomized carotid stenting trial, acute carotid occlusion, tandem stenosis, large pseudoaneurysm, high carotid bifurcation, and contralateral laryngeal nerve palsy. Procedures were technically successful in all but one lesion (99.2%). Perioperative stroke occurred in four cases (3.0%). Mean follow-up was 38 months (range 1–204 months), during which 23 vessels (17.3%) developed restenosis. Hostile-neck carotids (n=57) comprised 42.9% of all vessels treated and were responsible for 15 of 23 restenosis cases, resulting in a significantly higher restenosis rate than that of primary atherosclerotic lesions (26.3% vs 10.5%, p=0.017). By univariate analysis, the presence of calcified plaque was significantly associated with the incidence of in-stent restenosis (p=0.02).ConclusionsRestenosis rates after carotid angioplasty and stenting are low. Patients with a history of ipsilateral neck surgery or irradiation are at higher risk for substantial radiographic and symptomatic restenosis.

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

2011 ◽  
Vol 115 (4) ◽  
pp. 686-693 ◽  
Author(s):  
Vincent Costalat ◽  
Igor Lima Maldonado ◽  
Jean-François Vendrell ◽  
Carlos Riquelme ◽  
Paolo Machi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Recurrent Stroke ◽  
Neurological Complication ◽  
Arterial Stenosis ◽  
Technical Failure ◽  
Stent Restenosis ◽  
Stent System ◽  
The Mean ◽  
In Stent Restenosis

Object The limitations of the medical management of symptomatic intracranial arterial stenosis (SIAS) have encouraged the development of new strategies, such as endovascular treatment. In this study, the authors report and analyze a series of 63 endovascular procedures in which the Wingspan stent system was used. Methods Data from 60 patients presenting with refractory SIAS, treated in 5 French neurointerventional centers between September 2006 and August 2009, were retrieved. An angiogram was systematically obtained 6 months after the procedure and yearly thereafter. The clinical neurological status was assessed and reported using the modified Rankin scale at 1-month, 6-month, and 1-year follow-up visits. Results A total of 63 stenotic lesions was treated. The mean age of the patients was 65.3 years, and the mean diameter of the stenosis was 80.2%. Technical success was achieved in 95.2% of cases. The overall incidence of procedural complications was 20.6%, with a 4.8% rate of permanent postoperative morbidity and death. In-stent restenosis (ISR)/occlusion occurred in 11 cases (17.4%), of which 10 were asymptomatic and 9 were detected less than 1 year from the endovascular treatment. In 1 case, the patient presented with a recurrent transient ischemic attack and was treated again with angioplasty. The mean follow-up was 13.2 months. Conclusions Endovascular treatment of SIAS demonstrates a moderate risk of neurological complication. Nevertheless, considering the critical natural history of severe refractory lesions, this may be considered the first alternative in cases of failed medical therapy. 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.

scholarly journals Clinical Outcomes in type 2 Diabetes with in-stent Restenosis and Late/very Late Stent Thrombosis Undergoing Primary Percutaneous Coronary Intervention: A Single-center Observational Cohort Study

2020 ◽  
Author(s):  
Xiaoxiao Zhao ◽  
Jinying Zhou ◽  
Yu Tan ◽  
Zhaoxue Sheng ◽  
Jiannan Li ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Ischemic Stroke ◽  
Cell Count ◽  
Clinical Outcomes ◽  
Late Stent Thrombosis ◽  
Very Late Stent Thrombosis ◽  
Stent Restenosis ◽  
In Stent Restenosis

Abstract BACKGROUND: This study aimed to compare differences in the risk factors and clinical outcomes of type 2 diabetes mellitus (DM) and non-DM patients with de novo lesions (DNL), definite in-stent restenosis (ISR), and late or very late stent thrombosis (LST/VLST). METHODS: A total of 4151 patients with acute coronary syndrome were screened angiographically to determine DNL, ISR, and LST/VLST. A total of 3976 patients were included in the analysis and divided into DM (n=1302) or non-DM (n=2674) group at admission. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), defined as death, myocardial infarction, revascularization, and ischemic stroke within a 1-year follow-up period. RESULTS: In the group with total white blood cell count >10 10^9/L (p=0.004), neutral granular cell count >7 10^9/L (p=0.030), neutrophil-lymphocyte ratio >1.5 (p=0.041), DNL outperformed LST/VLST lesions in terms of revascularization at a median follow-up of 698 days. Among patients with DNL, the incidences of MACEs (log-rank p=0.0002), all-cause death (log-rank p=0.00032), cardiac-related death (log-rank p=0.021), and revascularization (log-rank p=0.029) were significantly lower in the non-DM group than in the DM group. However, no difference was observed in the event rates of endpoints among patients with ISR and LST/VLST between the non-DM and DM groups. Furthermore, among DM patients, there was a critically higher cumulative incidence of revascularization (log-rank p=0.0002) in the subgroup with ISR lesions and higher rate of ischemic stroke (log-rank p=0.033) in the subgroup with LST/VLST lesions. CONCLUSION: This study found that DM patients have a higher incidence of composite clinical outcomes than non-DM patients among patients with DNL. Compared with patients with DNL, patients with ISR lesions and LST/VLST lesions had more incidence of revascularization by long-term follow up. Thus, ISR and LST/VLST lesions are critical problems after coronary stenting, especially among DM patients.

P2549The cardiovascular predictors of clinical outcomes in patients after ischemic stroke of undetermined etiology

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bielecka-Dabrowa ◽  
P Gasiorek ◽  
A Sakowicz ◽  
M Banach
Keyword(s):  
Ischemic Stroke ◽  
Independent Predictor ◽  
Reference Group ◽  
Peak Velocity ◽  
Recurrent Stroke ◽  
Mitral Annular Velocity ◽  
Kaplan Meier ◽  
Unfavourable Prognosis ◽  
Undetermined Etiology

Abstract Purpose The study aimed to identify echocardiographic, hemodynamic and biochemical predictors of unfavourable prognosis after ischemic strokes of undetermined etiology (ESUS) in patients (pts) at age <65. Methods Out of 520 ischemic stroke pts we selected 64 pts diagnosed with ESUS [mean age 54 (SD: 47–58) years, 42% males] and additional 36 without stroke but with similar risk profile, which were treated as a reference group [age 53 (SD: 47–58) years, 61% males]. All pts underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer (Atcor Med., Australia), HDL subfraction distribution using Lipoprint (Quantimetrix) as well as measurements of selected biomarkers. Follow-up was 12 months. Results At 12-month follow-up 9% of patients had died, and recurrent ischemic stroke also occurred in 9% of patients - only in the ESUS group (Figure). Patients who died had significantly lower levels of LDL and HDL cholesterol (included HDL-8 and -9 subfractions) and higher level of triglicerides (p=0.01, p=0.01, and p=0.02; respectively), lower level of adiponectin (p=0.01), lower value of mean early diastolic (E') mitral annular velocity (p=0.04) and lower diastolic blood pressure (p=0.04). The atrial fibrillation (AF) occurred in 10% of pts during the 12 months (log-rang, p=0.254) (Figure). The log-rank test showed that ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization compared to reference group (11% vs 5%, p=0.041). Based on a Kaplan-Meier analysis, the outcome of re-hospitalizationin the 1st year was 28% (18/64) in the ESUS group and 17% (6/36); log-rank, p=0.058. In the multivariate analysis mean early diastolic (E') mitral annular velocity (odds ratio [OR] 0.75, 95% confidence interval [CI]: 0.6–0.94; p=0.01) was significantly associated with CV hospitalizations assessed at 12-month follow-up. The only independent predictor of AF occurrence in the 12-month follow-up was lower value of Tissue Doppler-derived right ventricular systolic excursion velocity S' (OR 0.65, 95% Cl 0.45–0.93; p=0.01). The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion as determined by pulsed wave Doppler (E/E') (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E' ratio was also independently associated with composite endpoint consisting of death, hospitalization and recurrent stroke (OR 1.90, 95% CI 1.1–3.2, p=0.01). Kaplan-Meier Analysis - survival and AF Conclusions The indices of diastolic dysfunction are significantly associated with unfavourable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during first 2 months after ESUS to detect potential AF. Acknowledgement/Funding The study was financed by research grants no. 502-03/5-139-02/502-54-229-18 of the Medical University of Lodz

Long-term follow-up of brachytherapy for treatment of allograft in-stent restenosis

2004 ◽  
Vol 61 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Gilbert J. Zoghbi ◽  
Vijay K. Misra ◽  
Gregory D. Chapman ◽  
William B. Hillegass ◽  
Brigitta C. Brott ◽  
...  
Keyword(s):  
Stent Restenosis ◽  
Long Term Follow Up ◽  
In Stent Restenosis

Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Tan Xu ◽  
Yonghong Zhang ◽  
Yingxian Sun ◽  
Chung-Shiuan Chen ◽  
Jing Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Hospital Discharge ◽  
Odds Ratio ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Antihypertensive Medications ◽  
History Of

Introduction: The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain. Hypothesis: We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events. Results: Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension. Conclusion: Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.

Abstract W P113: Prolonged Use of Clopidogrel and Aspirin and Stroke Risk in Intracranial Stenosis in SAMMPRIS

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Christine Holmstedt ◽  
Michael J Lynn ◽  
Tanya N Turan ◽  
Colin P Derdeyn ◽  
David Fiorella ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Statistical Power ◽  
Intracranial Stenosis ◽  
Antithrombotic Agent ◽  
Logrank Test ◽  
Major Hemorrhage ◽  
Exact Test ◽  
Lipid Disorder ◽  
Primary Endpoints ◽  
Event Rates

Background: In the SAMMPRIS trial, the use of combination aspirin and clopidogrel for 90 days after enrollment could be one reason that the outcome of patients in the medical arm was better than expected. The SAMMPRIS protocol required stopping clopidogrel after 90 days unless the patient had a non-neurological indication for continued use. We sought to compare outcomes in patients on vs. off clopidogrel beyond 90 days. Methods: For patients who did not have a primary endpoint within 90 days after enrollment (n = 397), we compared baseline features (t and Fisher’s exact tests), survival curves for the primary endpoint beyond 90 days after enrollment (the logrank test), and major hemorrhages (Fisher’s exact test) in patients on vs. off clopidogrel in the medical arm and stenting arms. Results: In the medical and stenting groups combined, baseline factors that were significantly (p<0.05) different between those on vs. off clopidogrel beyond 90 days (all higher in on clopidogrel group) were: age, diabetes, lipid disorder, coronary disease, SBP, and on antithrombotic agent at qualifying event. The table shows the primary endpoints and major hemorrhages in patients on vs. off clopidogrel in both treatment groups. Conclusion: This analysis, which was underpowered to detect even very large differences in event rates, suggests that prolonged use of clopidogrel plus aspirin may lower the risk of stroke in medically treated patients with intracranial stenosis, but increase the risk of major hemorrhage. Further studies with higher statistical power are needed to test this hypothesis.

scholarly journals Mehran in-stent restenosis classification adapted for coronary bifurcations: the impact on 4-year follow-up from randomized clinical studies POLBOS I and II

2018 ◽  
Vol 14 (3) ◽  
pp. 299-303 ◽  
Author(s):  
Jacek Bil ◽  
Robert J. Gil ◽  
Adam Kern ◽  
Luis A. Inigo-Garcia ◽  
Radosław Formuszewicz ◽  
...  
Keyword(s):  
Clinical Studies ◽  
Stent Restenosis ◽  
The Impact ◽  
In Stent Restenosis
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