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

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.

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Outcome of endovascular recanalization for intracranial in-stent restenosis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015607 ◽

2020 ◽

Vol 12 (11) ◽

pp. 1094-1098

Author(s):

Kaijiang Kang ◽

Feng Gao ◽

Dapeng Mo ◽

Ming Yang ◽

Yifan Liu ◽

...

Keyword(s):

Myocardial Infarction ◽

Endovascular Treatment ◽

Balloon Dilatation ◽

Recurrent Stroke ◽

Arterial Stenosis ◽

Long Term Outcome ◽

Stent Restenosis ◽

Significant Difference ◽

In Stent Restenosis

Background and purposeIn-stent restenosis (ISR) is one of the long-term adverse outcomes of endovascular angioplasty and stenting for symptomatic intracranial arterial stenosis. In this study, we try to evaluate the safety and efficacy of endovascular treatment for intracranial ISR.MethodsWe retrospectively collected patients with intracranial ISR who underwent endovascular treatment from June 2012 to August 2019 at a high-volume stroke center. Successful recanalization was defined as ≤30% residual stenosis. Stroke, myocardial infarction, and death after stenting within 30 days were used to evaluate periprocedural safety. Recurrent stroke in the territory of the culprit vessel and re-ISR in patients with clinical and vascular imaging follow-up data were used to evaluate the long-term outcome.Results32 patients (59.6±7.2 years old) with ISR were recruited, including 22 patients (68.8%) treated with balloon dilatation, 8 patients (25%) with stenting, and 2 patients (6.3%) with failed procedures. Successful recanalization was achieved in 71.9% (23/32) of patients. There was no stroke, myocardial infarction or death within 30 days after the procedure. Recurrent stroke was found in 10.7% (3/28) of the patients, and re-ISR was found in 42.1% (8/19) of the patients. The re-ISR rate was lower in patients with stenting than in those with balloon dilatation (0% vs 57.1%, p=0.090), and in patients with successful recanalization than in those with unsuccessful recanalization (33.3% vs 75.0%, p=0.352), but with no statistically significant difference.ConclusionsThe periprocedural safety of endovascular treatment for intracranial ISR may be acceptable, but the long-term rates of recurrent stroke and re-ISR remain at high levels.

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

Stroke ◽

10.1161/str.45.suppl_1.81 ◽

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.

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Microstent-Assisted Coiling for Wide-Necked Intracranial Aneurysms

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100016917 ◽

2005 ◽

Vol 32 (1) ◽

pp. 71-81 ◽

Cited By ~ 43

Author(s):

Marlise Peruzzo dos Santos Souza ◽

Ronit Agid ◽

Robert A. Willinsky ◽

Michael Cusimano ◽

Walter Montanera ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Neurological Complication ◽

Posterior Circulation ◽

Technical Failure ◽

Anterior Circulation ◽

Neck Size ◽

Clinical Complications ◽

Class 1

Objective:To describe the results, technical feasibility, efficacy and challenges encountered in our preliminary experience using a self-expandable microstent, optimized for intracranial use, as an adjunct in the endovascular treatment of wide-necked aneurysms.Methods:Only broad-necked aneurysms (dome-to-neck ratio £2, or an isolated neck size > 4.5 mm) were treated with Neuroform microstent from July 2003 to May 2004. The techniques used for stent deployment were either parallel or sequential. Angiographic results were recorded immediately for all patients and classified as Class 1 (complete occlusion), Class 2 (neck remnant) or Class 3 (sac remnant) by three interventional neuroradiologists not involved in the procedure. Follow-up angiography at six months was obtained for one case. Modified Rankin Score scale was assessed for all patients.Results:Seventeen intracranial aneurysms in a total of 18 patients were treated (mean age, 52.2 yr). Eight patients (44.4%) presented with acute subarachnoid hemorrhage. Eleven aneurysms (61.1%) were in the posterior circulation. Average dome size was 10.2 mm (range, 3.7-19.8 mm) and average neck size was 5.36 mm (range, 3.0-10.0 mm). Six out of seven aneurysms of the anterior circulation were approached with parallel technique. Eight aneurysms of the posterior circulation were approached with sequential technique. Average number of coils deployed was 9.64 (range, 4-23 coils). Eleven aneurysms (64.8%) resulted in Class 1 and/or Class 2. One technical failure was observed. Technical complications were recognized in four patients (23.5%), all of them with unruptured aneurysms in the anterior circulation. Two patients (11.7%) presented transient immediate clinical complications. One patient (5.8%) had minor permanent neurological complication. Neither major clinical complications nor death were encountered. Favorable clinical outcome (Modified Rankin Scale score 0-2) was observed in 88.2% of the patients (average follow-up time, 4.72 months).Conclusion:Absence of major permanent complications and satisfactory immediate obliteration degree in our preliminary experience indicates that microstent-assisted coiling technique is useful for the minimally invasive treatment of broad-necked complex aneurysms that are not ideal for conventional endovascular treatment and are at a high risk for conventional surgical treatment.

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Long-term outcomes of the micronet-covered stent system routine use for carotid revsacularization in stroke prevention: PARADIGM-Extend 5 year evidence

European Heart Journal ◽

10.1093/ehjci/ehaa946.2404 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Mazurek ◽

A Borratynska ◽

T Tomaszewski ◽

A Lesniak-Sobelga ◽

P Wilkolek ◽

...

Keyword(s):

Stroke Prevention ◽

Stroke Risk ◽

Duplex Ultrasound ◽

Funding Source ◽

Stent Restenosis ◽

Stent System ◽

System Use ◽

In Stent Restenosis

Abstract Background Diffusion-weighted magnetic resonance imaging indicates that micronet-covered embolic prevention stent system effectively minimizes peri-procedural and prevents lesion-related post-procedural cerebral embolism in carotid artery stenting but long-term clinical evidence is missing. Purpose To provide long-term clinical and duplex ultrasound evaluation of safety and efficacy of the system use in consecutive carotid revascularization patients. Methods PARADIGM-EXTEND is in all-comer, all-referrals-tracked study with no exclusion criteria other than lack of NeuroVascular Team-determined indication. Clinically asymptomatic patients receive revascularization only in case of increased-stroke-risk characteristics. Adverse events are independently adjudicated. Results Currently 451 patients (48–87 years, 59% symptomatic, 127 women) with 490 arteries crossed the first follow-up window of 30 days. There has been 100% micronet-covered embolic prevention stent system use (ie, no other stent type/s used throughout study). Proximal/distal intra-procedural neuroprotection use was 38.3%/61.7%. Large balloon/high-pressure stent optimization was routine, leading to a single-digit (mean 6.9%) residual diameter stenosis. Independent neurologist and duplex evaluation are before and after revascularization (48h and 30 days, then yearly). Peri-procedural death or major ischemic stroke rate was 0%. One event (prior infarct scar asymptomatic extension in prolonged hypotension course) was adjudicated as minor stroke (0.22%), and there was 1 periprocedural MI (type 2, in 2-vessel non-revascularizable CTO; 0.22%). By 30 days there were no further ischaemic strokes (0%) but there was 1 haemorrhagic transformation that led to death (0.22%) and 1 bleeding-related death (0.22%). Thus total 30-day death/stroke was 0.66%, and total death/stroke/MI was 0.88%. By 60 months there were 3 contralateral, 1 ipsilateral (device-unrelated), and 2 posterior circulation strokes. Baseline internal carotid artery velocities were 3.72±1.25 and 0.63±0.69 m/s (peak-systolic and end-diastolic). Post-procedural in-stent velocities were normal and remained normal throughout the 60-month follow-up period: 0.78±040 and 0.21±0.10 (1y); 0.75±0.36 0.19±0.09 (2y); 0.75±0,35 and 0.21±0.09 (3y); 0.72±0.27 and 0.20±0.07 (4y); 0.79±0.58 and 0.21±0.11m/s (5y). There were 2 in-stent restenoses by 1y (including 1 that occurred with de novo neck radiotherapy) and 1 other by 2y (total 2y in-stent restenosis of 1.1%) but no further ones (0% in-stent restenosis at 2–5y). Conclusions PARADIGM-Extend long-term clinical and duplex ultrasound evidence is consistent with normal healing and sustained safety and stroke prevention efficacy of the micronet-covered embolic prevention stent system used routinely, on top of optimized medical therapy, for stroke prevention in symptomatic and increased-stroke-risk asymptomatic subjects with carotid stenosis recommended for revasularization by the NeuroVascular Team. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Jagiellonian University Medical College

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Endovascular Recanalization of the Subacute to Chronically Occluded Basilar Artery

Neurosurgery ◽

10.1227/01.neu.0000367611.78898.a3 ◽

2010 ◽

Vol 66 (4) ◽

pp. 825-832 ◽

Cited By ~ 16

Author(s):

Shervin R. Dashti ◽

Min S. Park ◽

Michael F. Stiefel ◽

Cameron G. McDougall ◽

Felipe C. Albuquerque

Keyword(s):

Median Time ◽

Basilar Artery ◽

Medical Management ◽

Endovascular Techniques ◽

Endovascular Recanalization ◽

Stent Restenosis ◽

Scale Scores ◽

The Mean ◽

In Stent Restenosis

Abstract INTRODUCTION Occlusion of the basilar artery (BA) has a poor prognosis. We evaluated technical considerations and complications associated with reopening subacute to chronically occluded BAs. METHODS Duration of BA occlusion before revascularization, symptoms and medical management before treatment, and postprocedural antiplatelet regimen and anticoagulation protocols of 9 patients were analyzed. All patients underwent endovascular low-volume balloon angioplasty followed by Wingspan stenting. RESULTS The median time between onset of symptoms and treatment was 5 days (range, 2 days to 3.5 years). The median time between documentation of BA occlusion by cerebral angiography or computed tomography angiography and treatment was 3 days (range, 1 day to 8 months). Recanalization was successful in 8 of the 9 patients. Immediately after the procedure, 4 patients were stable, 3 patients improved, and 2 patients were worse. Four patients had periprocedural complications. Four of the 9 patients died, 2 from periprocedural complications. The mean clinical duration of follow-up was 11 months. At latest follow-up, the modified Rankin Scale scores for the 5 surviving patients were 0, 0, 2, 2, and 3, respectively. During the follow-up period, 4 patients improved, 1 patient remained stable, and 1 patient died. The mean angiographic follow-up was 8.6 months. Two patients developed significant in-stent stenosis during this period. CONCLUSION With current endovascular techniques, recanalization of chronically occluded BAs is feasible. The procedure carries substantial risks and should be reserved for patients with medically refractory symptoms. Careful postprocedural medical management and radiographic follow-up are warranted to prevent in-stent restenosis.

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Impact of Cilostazol Administration on Femoropopliteal In-Stent Restenosis

Journal of Endovascular Therapy ◽

10.1177/1526602817719284 ◽

2017 ◽

Vol 24 (5) ◽

pp. 640-646 ◽

Cited By ~ 3

Author(s):

Yusuke Tomoi ◽

Yoshimitsu Soga ◽

Osamu Iida ◽

Masahiko Fujihara ◽

Kenji Ando

Keyword(s):

Positive Impact ◽

Velocity Ratio ◽

Peak Systolic Velocity ◽

Target Lesion ◽

Stent Restenosis ◽

Secondary Endpoints ◽

The Mean ◽

Negative Predictor ◽

In Stent Restenosis

Purpose: To investigate whether administering cilostazol after treatment for femoropopliteal in-stent restenosis (ISR) can have a positive impact on recurrent ISR (Re-ISR). Methods: The database of a multicenter, retrospective, observational registry was interrogated to identify 338 consecutive patients (mean age 72.3±8.8 years; 148 men) who underwent endovascular therapy for femoropopliteal ISR in 379 limbs from January 2010 to December 2014. Ninety-seven patients (103 limbs) who received cilostazol after the initial stent implantation procedure were excluded. This left 24 ISR patients (30 limbs) who received cilostazol initially after ISR treatment for comparison with 217 ISR patients (246 limbs) who did not receive the drug. The primary endpoint was 2-year Re-ISR after treatment. The secondary endpoints were recurrent target lesion revascularization (Re-TLR) and reocclusion at 2 years. Restenosis was determined by a peak systolic velocity ratio >2.4 on a duplex scan or >50% stenosis on angiography. Results: The mean follow-up was 23.3±15.5 months. At 2 years, freedom from Re-ISR was significantly higher in the cilostazol group than in the no cilostazol group (48.6% vs 32.4%, p=0.047). However, freedom from Re-TLR and reocclusion between the 2 groups did not differ significantly [64.7% vs 53.8% (p=0.15) and 88.3% vs 73.9% (p=0.11), respectively]. After adjusting for prespecified risk factors, cilostazol administration was a negative predictor of Re-ISR. Conclusion: This small comparative study suggests that administering cilostazol for ISR lesions after femoropopliteal stenting reduces recurrent ISR.

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Preprocedural Mean Platelet Volume Level Is a Predictor of In-Stent Restenosis of the Superficial Femoral Artery Stents in Follow-Up

Cardiology Research and Practice ◽

10.1155/2018/4572629 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Kurtulus Karauzum ◽

Ulas Bildirici ◽

Emir Dervis ◽

Irem Karauzum ◽

Canan Baydemir

Keyword(s):

Femoral Artery ◽

Superficial Femoral Artery ◽

Mean Platelet Volume ◽

Strong Predictor ◽

Platelet Volume ◽

Roc Curve Analysis ◽

Stent Restenosis ◽

The Mean ◽

In Stent Restenosis

Background. The mean platelet volume (MPV), the most commonly used measure of the platelet size, is a cheap and easy-to-use marker of the platelet activation. We aimed to evaluate the relationship between preprocedural MPV and other hematologic blood count parameters and in-stent restenosis in patients with superficial femoral artery (SFA) stenting.Methods and Results. The consecutive 118 patients who successfully underwent endovascular stenting of the SFA were enrolled retrospectively in the study. The mean follow-up was 23 ± 12 months. The in-stent restenosis was observed in 42 patients (35.6%). There were no statistically significant differences between the restenosis group and no-restenosis group in terms of age, gender, and smoking (p=0.116,p=0.924, andp=0.428, resp.). In the restenosis group, the MPV level was markedly higher than that in the no-restenosis group, and it was statistically significant (p<0.001). According to the ROC curve analysis, the optimal cutoff value of the MPV to determine the restenosis was >8.7 fL, and the level of the MPV >8.7 fL was a strong predictor of the restenosis (p<0.001) in logistic regression analysis.Conclusions. The measurement of the preprocedural MPV levels may help to identify high-risk patients for development of the in-stent restenosis. These patients may benefit from an aggresive antiplatelet therapy and close follow-up.

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Comparison of 3D T1-SPACE and DSA in evaluation of intracranial in-stent restenosis

British Journal of Radiology ◽

10.1259/bjr.20190950 ◽

2020 ◽

pp. 20190950

Author(s):

Qiuji Shao ◽

Qiang Li ◽

Qiaowei Wu ◽

Tianxiao Li ◽

Li Li ◽

...

Keyword(s):

Correlation Coefficient ◽

Stent Implantation ◽

Pearson Correlation ◽

Arterial Stenosis ◽

Pearson Correlation Coefficient ◽

Non Invasive ◽

Stent Restenosis ◽

Space Technique ◽

In Stent Restenosis

Objective: In-stent restenosis (ISR) after stenting for intracranial stenosis is a significant issue. This study aimed to evaluate the usefulness of the 3D T1-SPACE technique in the follow-up of patients after stent implantation. Methods: Fifteen patients with intracranial arterial stenosis were prospectively enrolled 6–8 months after stenting. Digital subtraction angiography (DSA) and 3D T1-SPACE imaging were performed to evaluate the degree of stenosis and the enhancement of the vessel wall. Bland–Altman plots were used to assess the agreement between the two imaging methods, and the Pearson correlation coefficient was calculated as a measure of the linear correlation. Results: Eight Enterprise stents and seven Wingspan stents were used in 15 patients. The follow-up DSA after 6–8 months showed that the degree of stenosis was 40% (range, 30–72%), and ISR occurred in 4 of 15 (26.7%) lesions. The degree of stenosis assessed using the 3D T1-SPACE imaging technique was 35% (range, 30–75%). All four patients with ISR demonstrated significant enhancement. The Pearson correlation coefficient between the two methods was 0.959 (p < 0.05), and the Bland–Altman plot showed that all data points were within the consistency limits ([Formula: see text] ± 1.96 s). Conclusion: As a non-invasive imaging modality, 3D T1-SPACE showed great consistency with DSA in measuring the degree of stenosis after intracranial stenting. It may be used as an optional method for detecting ISR. Advances in knowledge: This study evaluated the usefulness of 3D T1-SPACE technique in the follow-up of patients after stent implantation, which could be used as an optional and non-invasive method in detection of in-stent restenosis.

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Visit-to-Visit HbA1c Variability is Associated with In-Stent Restenosis in Patients with Type 2 Diabetes after Percutaneous Coronary Intervention

10.21203/rs.3.rs-30051/v2 ◽

2020 ◽

Author(s):

Chen Die Yang ◽

Ying Shen ◽

Lin Lu ◽

Zhen Kun Yang ◽

Jian Hu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Stent Implantation ◽

Coronary Intervention ◽

Diabetic Patients ◽

Stent Restenosis ◽

Percutaneous Coronary ◽

The Mean ◽

In Stent Restenosis

Abstract Background: Patients with type 2 diabetes are under substantially higher risk of in-stent restenosis (ISR) after coronary stent implantation. We sought to investigate whether visit-to-visit HbA1c variability is a potential predictor of ISR in diabetic patients after stent implantation.Methods: We consecutively enrolled type 2 diabetic patients who underwent successful elective percutaneous coronary intervention and performed follow-up coronary angiography after around 12 months. The incidence of ISR and its relationship with visit-to-visit HbA1c variability, expressed as coefficient of variation (CV), standard deviation (SD) and variability independent of the mean (VIM), were studied. Multivariable Cox proportional hazards models were constructed to analyze the predictive value of HbA1c variability for ISR.Results: From September 2014 to July 2018 in Ruijin Hospital, a total of 420 diabetic patients (688 lesions) after stent implantation were included in the final analysis. During a mean follow-up of 12.8±1.3 months, the incidence of ISR was 8.6%, which was significantly increased in patients with higher CV of HbA1c (P=0.001). The mean diameter stenosis (DS), net luminal loss and net luminal gain were 22.9±16.8%, 0.42±0.88 mm and 1.66±0.83 mm, respectively. Greater DS was observed in subjects with higher tertiles of CV of HbA1c (P<0.001), and this trend was more prominent in patients with optimal glycemic control (HbA1c≤7%) in the baseline. In multivariate analysis, HbA1c variability was independently associated with incidence of ISR after adjustment for traditional risk factors and mean HbA1c (HR: 3.00 [95% CI:1.14~7.92] for highest vs. lowest tertile). Inclusion of CV of HbA1c led to a better risk stratification accuracy. Assessing HbA1c variability by SD or VIM yielded similar findings. Conclusions: This study suggests that visit-to-visit HbA1c variability is an independent predictor of incidence of ISR in patients with type 2 diabetes after stent implantation.Trial registration: Trials number, NCT02089360; registered on March 17,2014.

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Endovascular Treatment of Symptomatic Intracranial Arterial Stenosis: Six-Year Experience in a Single-Center Series of 42 Consecutive Patients With Acute and Mid-Term Results

Neurosurgery ◽

10.1227/neu.0b013e3181f7ef1f ◽

2010 ◽

Vol 67 (6) ◽

pp. 1505-1514 ◽

Cited By ~ 11

Author(s):

Vincent Costalat ◽

Igor Lima Maldonado ◽

Jean-Baptiste Zerlauth ◽

Nicolas Menjot ◽

Carlos Riquelme ◽

...

Keyword(s):

Endovascular Treatment ◽

Coronary Stents ◽

Arterial Stenosis ◽

Intracranial Arterial Stenosis ◽

Intracranial Stent ◽

Stent System ◽

Procedural Complications ◽

History Of ◽

Permanent Morbidity ◽

The Mean

Abstract BACKGROUND: The limitations of the medical management of symptomatic intracranial arterial stenosis encourage the development of new therapeutic strategies such as intracranial stenting. OBJECTIVE: To report and analyze the results of a series of 42 patients treated with 3 different endovascular techniques: isolated angioplasty, balloon-expandable coronary stents, and the Wingspan self-expandable intracranial stent system. METHODS: Forty-two patients presenting with symptomatic intracranial arterial stenosis were treated with one of these techniques. Computed tomography angiography was performed 6 months after the procedure, and the clinical neurological statuses were categorized using the modified Rankin Scale and the National Institutes of Health Stroke Scale. RESULTS: A total of 42 lesions were treated: 9 with isolated angioplasty, 14 with balloon-expandable coronary stents, and 19 with Wingspan self-expandable intracranial stents. The mean patient age was 62.9 years, and the mean arterial diameter stenosis was 73.9%. Technical success was achieved in 97.6% of the patients. The overall incidence of procedural complications was 21.4%, and the postoperative permanent morbidity/mortality rate was 7.1%. There were 3 cases of in-stent thrombosis (1 fatal) and 5 cases of asymptomatic restenosis (11.9%), 3 in the isolated angioplasty group and 2 in the Wingspan self-expandable intracranial stent group (mean follow-up 20.4 months). The rate of restenosis was higher in the angioplasty group (33%) than in the coronary (0%) and Wingspan stent (10.5%) groups. CONCLUSION: Endovascular treatment of symptomatic intracranial stenosis has significant overall morbidity and mortality rates. Nevertheless, the very critical natural history of severe refractory lesions and the relatively favorable postoperative evolution suggest that it should be considered the first alternative strategy in cases in which medical therapy has failed.

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