Abstract
Background: Endovascular treatment for intracranial atherosclerotic stenosis (ICAS) has been developed. However, the intracranial internal carotid artery (ICA) presents a particular challenge due to the location and tortuous route, and the outcomes of endovascular treatment in patients with stenosis of the intracranial ICA still have not been reported. This article retrospectively investigated the 30-day and 1-year outcomes of tailored endovascular treatment for patients with severe intracranial ICA stenosis from a single center.Methods: Between June 2014 and December 2017, 96 consecutive patients with severe atherosclerotic stenosis (70–99%) of the intracranial ICA were managed with endovascular treatment in Beijing Tiantan Hospital. Three different kinds of treatments [angioplasty with balloon dilatation alone (BD group), balloon-mounted stent (BMS group), and self-expanding stent (SES group)] were performed according to the characteristics of the lesions. The primary endpoints included any stroke or death within 30 days and ipsilateral ischemic stroke afterwards within 1 year. Secondary endpoints included the revascularization success rate (residual stenosis <30%) and the restenosis rate (stenosis ≥ 50%) within 1 year.Results: The 30-day death rate was 0, and the stroke rate of all patients was 7.3% (7/96). The stroke rate was higher in the BD group (15.8%) and SES group (9.8%) than in the BMS group (0%) (p = 0.047). Thirteen (13.5%) patients suffered at least one onset of ischemic stroke in the ipsilateral ICA territory within 1 year, and there was no significant difference among the three groups (p = 0.165). The overall revascularization success rate was 93.8%, and the revascularization success rate was significantly higher in the SES group (100%) than in the BD group (78.9%) (p = 0.006). The restenosis rate of all patients within 12 months was 20.8%, and there was no significant difference among the three groups. Patients with Mori type C target lesions were more likely to suffer stroke within 30 days (25%) and restenosis within 1 year (31.3%).Conclusions: Both the 30-day and 1-year outcomes of tailored endovascular treatments seemed to be acceptable in the treatment of symptomatic atherosclerotic stenosis of the intracranial ICA. However, this needs to be confirmed by further investigation, preferably in large multicenter randomized controlled clinical trials.
Highlights
Intracranial atherosclerotic stenosis (ICAS) is a common etiology of stroke worldwide, with the highest prevalence being in Asian, Hispanic, and African populations and ICAS accounting for approximately half of transient ischemic attacks (TIAs) and ischemic strokes in Asian populations [1, 2]
This was the first study with a 1-year outcome of endovascular treatment for severe intracranial internal carotid artery (ICA) stenosis, and it had a larger sample than prior studies
Our study revealed that the 30-day stroke rate of patients with severe intracranial ICA atherosclerotic stenosis was 7.3 and 13.5% patients suffered at least one onset of ischemic stroke in the ipsilateral ICA territory within the 1-year follow-up
Summary
Intracranial atherosclerotic stenosis (ICAS) is a common etiology of stroke worldwide, with the highest prevalence being in Asian, Hispanic, and African populations and ICAS accounting for approximately half of transient ischemic attacks (TIAs) and ischemic strokes in Asian populations [1, 2]. Two randomized controlled trials [Stenting and Aggressive Medical Management Therapy for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) and Vitesse Intracranial Stent Study for Ischemic Therapy (VISSIT)] did not show superiority of stenting over aggressive medical management alone for ICAS, with a high incidence of periprocedural complications and recurrent stroke [6, 7]. Restenosis is another major drawback with a rate of up to 34% [8]. This article retrospectively investigated the 30-day and 1-year outcomes of tailored endovascular treatment for patients with severe intracranial ICA stenosis from a single center
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
