Abstract
Background and Purpose: Subgroup analysis of the SAMMPRIS trial showed a higher rate of periprocedural perforator strokes with the Wingspan stent in the basilar artery in patients with symptomatic intracranial atherosclerotic stenosis (ICAS). It remains unclear whether angioplasty (PTA) alone or in combination with other stent types (PTAS) will yield similar results in perforator-bearing segments of the anterior and posterior circulation.Methods: We retrospectively analyzed the periprocedural complication rate, long term outcome and stroke etiology in 59 consecutive patients with ICAS of the middle cerebral artery (79 treatments) and 67 patients with ICAS of the intracranial vertebral and basilar artery (76 treatments) treated with PTA or PTAS from 2007 to 2015 in a high-volume neuro-interventional center.Results: Periprocedural symptomatic ischemic strokes occurred significantly more often in patients with posterior vs. anterior ICAS treatment (14.5 vs. 5.1%, p = 0.048). During a mean follow-up period of 19 (±23.7) months, 5 recurrent ischemic and 2 hemorrhagic strokes (10.4%) occurred in the territory of the treated artery in posterior circulation compared to 2 ischemic strokes in the anterior circulation (3.4%, p = 0.549). Overall, significantly more patients treated for a posterior ICAS suffered a periprocedural or follow-up stroke [25% vs. 11.4%, p = 0.024]. Periprocedural ischemic strokes were predominantly perforator strokes (73.3%), while all ischemic strokes during follow-up were caused by distal embolization (57.1%) or delayed stent occlusion (42.9%). There was no difference between PTA alone and PTAS.Conclusion: The periprocedural and long-term symptomatic stroke rate was significantly higher in the treatment of perforator-bearing arteries in the posterior circulation. There was no difference between PTA alone or PTAS.
Highlights
Symptomatic intracranial atherosclerotic stenosis (ICAS) is thought to be one of the leading causes of ischemic stroke worldwide due to a much higher prevalence in Asians compared to Caucasians [1] and bears a high risk of stroke recurrence [2]
In November 2016 the European Stroke Organization stated in their Karolinska Stroke Update (ESO-KSU) [10] that percutaneous transluminal angioplasty (PTA) or percutaneous transluminal angioplasty and stenting (PTAS) carried out by experienced personnel may be considered in a few special situations in patients with symptomatic ICAS (Grade C evidence) only and claimed further studies
We retrospectively reviewed all neurointerventional angioplasty and stenting procedures from January 2007 to February 2015 and identified all interventional procedures performed in perforatorbearing segments of symptomatic ICAS (M1-segment of the middle cerebral artery (MCA), V4-segment of the vertebral artery (V4)-segment of the VA and/or basilar artery (BA)) with documented preceding transient ischemic attack or ischemic stroke in a tertiary high-volume center
Summary
Symptomatic intracranial atherosclerotic stenosis (ICAS) is thought to be one of the leading causes of ischemic stroke worldwide due to a much higher prevalence in Asians compared to Caucasians [1] and bears a high risk of stroke recurrence [2]. A detailed analysis in the SAMMPRIS trial using the Wingspan stent showed that the majority of periprocedural ischemic strokes (within 30 days after randomization) were caused by occlusion of perforator arteries [7]. Subgroup analysis of the SAMMPRIS trial showed a higher rate of periprocedural perforator strokes with the Wingspan stent in the basilar artery in patients with symptomatic intracranial atherosclerotic stenosis (ICAS). It remains unclear whether angioplasty (PTA) alone or in combination with other stent types (PTAS) will yield similar results in perforator-bearing segments of the anterior and posterior circulation
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