Intracranial Stent Placement for Recanalization of Acute Cerebrovascular Occlusion in 32 Patients

Background: The pre-maturely discontinued Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial demonstrated lack of benefit of intracranial stent placement due to high rates of immediate post procedure complications. The rates of complications were higher than those reported previously raising the question whether such results were representative of intracranial stent placement in actual routine practice. Objective: To ascertain and compare the rate of outcomes between patients who underwent intracranial stent placement within and outside clinical trials. Materials/Methods: Using the Nationwide Inpatient Sample (NIS) from 2008 to 2010, patients with cerebral ischemic events who underwent intracranial stent placement were identified using ICD-9 diagnosis and procedure codes. Patients were divided into those who received intracranial stent placement as part of the clinical trial and those who were treated outside any trial. The postoperative mortality, stroke and cardiac complications were primary endpoints. Results: A total of 3447 patient underwent intracranial stent placement, 223 patients (6.5%) were enrolled in a clinical trial. Patients who received intracranial stent placement as part of the clinical trial were significantly younger (65±10 versus 68±13 years, p=0.008). Both groups did not differ in terms of gender, race and ethnicity and medical co-morbidities. Mean length of stay was longer in patients treated outside a clinical trial (9.1±11 versus 5.1±4, p<0.0001). The rate of composite endpoint of postoperative mortality (9.6% versus 4.5%), postoperative stroke (4.6% versus 0%), and cardiac complications (1% versus 0%) was significantly higher in patients treated with intracranial stent placement outside clinical trial compared with those treated within clinical trials (14.2% versus 4.5%, p = 0.04). Conclusions: Patients who undergo intracranial stent placement outside a clinical trial have higher rates of postoperative stroke, cardiac complication and mortality. Such results support those of the SAMMPRIS trial and the need for restricting these procedures to selected patients and specialized centers with high experience.

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Abstract TP422: Comparison of Natural History and Effect of Intracranial Stent Placement Between Patients With Intra-Dural and Those With Sub-Arachnoid Intracranial Arterial Stenosis

Stroke ◽

10.1161/str.51.suppl_1.tp422 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sargun S Walia ◽

Wei Huang ◽

Iryna Lobanova ◽

Farhan Siddiq ◽

Brandi R French ◽

...

Keyword(s):

Ischemic Stroke ◽

Natural History ◽

Stent Placement ◽

Cerebral Hemorrhage ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Arterial Stenosis ◽

Intracranial Arterial Stenosis ◽

Intracranial Stent ◽

Subarachnoid Spaces

Background: Intracranial stenosis can be located in intradural or subarachnoid space. It is unclear whether there are any differences in ipsilateral ischemic stroke risk, cerebral hemorrhage and death in response to stent placement in these two locations. Methods: We analyzed Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) data. We divided the patients based on location of arterial stenosis: intradural [petrous internal carotid artery (ICA), pre-cavernous ICA, cavernous ICA or pre-posterior inferior cerebellar artery (PICA) vertebral artery] and subarachnoid [post-cavernous ICA, middle cerebral artery, vertebral artery at the level of or distal to origin of PICA, or basilar artery]. Cox proportional hazards analyses were used to determine the effect of intradural versus subarachnoid location on risk of ipsilateral ischemic stroke, cerebral hemorrhage or death during the follow-up period. Results: A total of 451 patients with stenosis located in intradural (n=74, 16.4%) or subarachnoid (n=377, 83.5 %) spaces were followed for a mean (SD) period of 29.06 (15.22) months after randomization. The rate of ischemic stroke seen in intradural and subarachnoid spaces was 11.86% and 14.58%, respectively. The rate of cerebral hemorrhage in the intradural and subarachnoid spaces was 1.35% and 2.92 %, respectively. The rate of death in the intradural and subarachnoid spaces was 10.81% and 1.59%, respectively. In Cox proportional hazards analyses, the risk of ipsilateral ischemic stroke (HR 1.08, P = 0.46), cerebral hemorrhage (HR 1.05, P = 0.59) and death (HR 0.9, P = 0.9) was not significantly different between patients with intradural arterial stenosis and those with subarachnoid arterial stenosis. The interaction between location of stenosis and treatment (intracranial stent versus best medical treatment) was not significant for the either ipsilateral ischemic stroke (p= 0.21), cerebral hemorrhage (p= 0.18) or death (p=0.15). Conclusion: We did not find any evidence to suggest that there was any difference in natural history or response to intracranial stent placement in patients with intradural location of stenosis compared with those with subarachnoid location.

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Okuläres Ischämiesyndrom: Diagnostik und Therapie

Karger Kompass Ophthalmologie ◽

10.1159/000520268 ◽

2021 ◽

pp. 1-3

Author(s):

Nicolas Feltgen

Keyword(s):

Visual Impairment ◽

Stent Placement ◽

Radiographic Examination ◽

Severe Stenosis ◽

Intracranial Stent ◽

Ocular Ischemic Syndrome ◽

Diagnostik Und Therapie ◽

Ica Stenosis ◽

Artery Flow ◽

Ischemic Syndrome

Background: Treatment of cervical internal carotid artery (ICA) stenosis has contributed to the improvement of ocular ischemic syndrome. However, there have been few cases of visual impairment caused by ocular ischemic syndrome due to intracranial ICA stenosis, which improved through intracranial stent placement. Cas description: A 76-year-old man presented with right-sided paralysis. Radiographic examination revealed severe stenosis of the left intracranial ICA (distal cavernous-infraclinoid portion) and a watershed infarction of the left cerebral hemisphere. Conservative therapy including antiplatelet drugs was initiated, but severe visual acuity disturbance in his left eye occurred 1 month after onset. The antegrade ocular artery flow recovered after urgent intracranial stent placement, and his vision improved immediately after the procedure. Conclusion: Visual impairment presenting as ocular ischemic syndrome can occur due to severe stenosis of the intracranial ICA, and treatment of these lesions could improve the symptoms.

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Intracranial Stent Placement to Trap an Extruded Coil During Endovascular Aneurysm Treatment: Technical Note

Neurosurgery ◽

10.1093/neurosurgery/46.1.248 ◽

2000 ◽

Vol 46 (1) ◽

pp. 248-253 ◽

Cited By ~ 39

Author(s):

Richard D. Fessler ◽

Andrew J. Ringer ◽

Adnan I. Qureshi ◽

Lee R. Guterman ◽

L. Nelson Hopkins

Keyword(s):

Stent Placement ◽

Technical Note ◽

Intracranial Stent ◽

Aneurysm Treatment

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Percutaneous intracranial stent placement for aneurysms

Journal of Neurosurgery ◽

10.3171/jns.2003.99.1.0023 ◽

2003 ◽

Vol 99 (1) ◽

pp. 23-30 ◽

Cited By ~ 61

Author(s):

Patrick P. Han ◽

Felipe C. Albuquerque ◽

Francisco A. Ponce ◽

Christopher I. Mackay ◽

Joseph M. Zabramski ◽

...

Keyword(s):

Stent Placement ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Parent Vessel ◽

Vessel Occlusion ◽

Content Type ◽

Intracranial Stent ◽

Parent Vessel Occlusion ◽

Vertebrobasilar Junction ◽

Fine Print

Object. Intracranial stent placement combined with coil embolization is an emerging procedure for the treatment of intracranial aneurysms. The authors report their results using intracranial stents for the treatment of intracranial aneurysms. Methods. A prospectively maintained database was reviewed to identify all patients with intracranial aneurysms that were treated with intracranial stents. Ten lesions, including eight broad-based aneurysms and two dissecting aneurysms, were treated in 10 patients. Four lesions were located in the cavernous segment of the internal carotid artery, two at the vertebrobasilar junction, two at the basilar trunk, one at the basilar apex, and one in the intracranial vertebral artery. Attempts were made to place stents in 13 patients, but in three the stents could not be delivered. Altogether, intracranial stents were placed in 10 patients for 10 lesions. Results that were determined to be satisfactory angiographically were achieved in all 10 lesions. Two patients suffered permanent neurological deterioration related to stent placement. In two patients, the aneurysm recurred after stent-assisted coil embolization. In one case of recurrence a second attempt at coil embolization was successful, whereas in the second case of recurrence parent vessel occlusion was required and well tolerated. Conclusions. Intracranial stents can be a useful addition to coil embolization by providing mechanical, hemodynamic, and visual benefits in the treatment of complex, broad-based aneurysms.

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