Abstract WP118: Incidence and Management of Re-stenosis in Patients Stented for Intracranial Atherosclerotic Disease: A Consecutive Series of 226 Patients

Abstract

Introduction: Angioplasty and stenting for intracranial atherosclerotic disease can re-establish adequate luminal diameter in highly stenotic arteries and improve cerebral blood flow. As in other vascular territories, intracranial stented arteries may develop delayed re-stenosis due to progression of atherosclerotic disease or endothelial hyperplasia. The primary strategies for management of re-stenosis have included aggressive medical therapy, angioplasty only, and repeat angioplasty and stenting. Materials and Methods: A total of 226 patients underwent intracranial angioplasty and stenting for symptomatic ICAD from 2000-2017. Patients were treated with balloon expandable coronary stents until 2002, when self-expanding intracranial nitinol stents became available. The series included: 21 balloon expandable coronary stents, 33 Neuroform stents, 37 Enterprise stents, and 135 Wingspan stents. Of this group, 210 patients had delayed follow up intracranial vascular imaging at 6 months, 1 year, and longer. In follow up, 24 of the 210 patients (11.4 %) developed significant re-stenosis, defined as 70% or greater. Eleven of the patients were symptomatic and 13 had no symptoms. A total of 17 patients underwent endovascular treatment of their re-stenosis, and 7 had medical management only. Results: The mean time interval for re-stenosis was 8.7 months. Of the 17 patients treated with endovascular therapy for re-stenosis, 4 patients had angioplasty only and 13 patients had angioplasty and stenting. There was one peri-procedural stroke in this group (5.9%) and no other strokes in the follow up period (mean 2.4 years, range 6 months - 7 years). Of the 7 patients who were managed medically, 1 patient had a stroke (14.3%) in the follow up period at 10 months (mean follow up 2.1 years, range 3 months - 5 years). Discussion: The preliminary data from this study suggests that patients with severe re-stenosis may be at significant risk of stroke, even if the re-stenosis is currently asymptomatic. As with other vascular territories, re-stenosis can be managed with multiple modalities, but repeat angioplasty and stenting in this series appears to be a low risk and viable option for these patients compared with medical therapy alone.