Stenting For Intracranial Stenosis Research Articles

Angioplasty and Stenting of Intracranial Stenosis

Angioplasty and Stenting of Intracranial Stenosis - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2020.044, IP Indian Journal of Neurosciences-IP Indian J Neurosci

Endovascular Therapy for Intracranial Artery Stenosis: Results from the Japanese Registry of Neuroendovascular Therapy (JR-NET)3.

A total of 907 patients enrolled in the Japanese Registry of Neuroendovascular Therapy (JR-NET)3, a surveillance study in Japan, who underwent intracranial percutaneous transluminal angioplasty (PTA)/stenting for intracranial stenosis during the period from 2010 to 2014 were investigated. Technical success was achieved in 97.5% of the patients, and 6.8% had a residual stenosis of ≥50%. The incidence rates of ischemic and hemorrhagic complications were as low as 5.3% and 3.1%, respectively, and the mortality rate was 1.9%. However, the mortality rate of cases with either complications was higher at 10.7%. About half of the treatment cases were performed between 24 h and 14 days after onset, and the incidence of perioperative complications was similar to that after at least 15 days. Although it is necessary to verify the effectiveness of PTA/stenting within 14 days, the results of this treatment were stable regardless of the intervention period.

Angioplasty and Stenting for Intracranial Stenosis

Of the patients enrolled in the Japanese Registry of Neuroendovascular Therapy (JR-NET), a surveillance study in Japanese, 1133 patients who underwent intracranial percutaneous transluminal angioplasty (PTA)/stenting for intracranial stenosis during the period from 2005 to 2009 were investigated. A technical success was achieved in 98.3% of the patients, and 70.5% and 7.5% had a residual stenosis of < 30% and ≥ 50%, respectively. The incidence of ischemic complications and hemorrhagic complications was as low as 7.7% and 2.5%, respectively, but tended to increase in patients who underwent stenting. While a significant correlation with ischemic complications was observed in previously untreated patients and patients who underwent stenting followed by post-dilatation, a significant correlation with hemorrhagic complications was observed in patients who received emergency treatment and those treated between 24 hours and 14 days of the onset. Flexible intracranial stents are expected to contribute to improvement in the treatment outcome.

Superiority of Aggressive Medical Therapy vs. Stenting for Intracranial Stenosis Confirmed in Analysis of Long-Term Outcomes

Superiority of Aggressive Medical Therapy vs. Stenting for Intracranial Stenosis Confirmed in Analysis of Long-Term Outcomes

Abstract 126: Wingspan Stent Largest Series Outside SAMMPRIS: Long-term Results

Objective: Intracranial stenosis is a common culprit for stroke which has been traditionally managed with medical therapy. However, recurrent TIA or stroke symptoms often occur despite aggressive management with antiplatelet medications. As such, angioplasty and stenting of intracranial vasculature has become an attractive idea for treatment of intracranial stenosis refractory to medical treatment. Because the SAMMPRIS trial was terminated prematurely, long term data regarding efficacy is lacking. We present the results of our series of 61 patients who underwent Wingspan stent placement for intracranial stenosis and evaluate the short-term and long-term success. Methods: Sixty-one patients with high-grade, symptomatic intracranial stenosis underwent Wingspan stent embolization at Jefferson Hospital for Neuroscience from August 7, 2006 to July 13, 2011. The clinical charts were reviewed to evaluate presentation, intervention, perioperative course, and outcome. Results: Our series consisted of 61 patients who received a Wingspan stent for intracranial stenosis(41 male; 20 female; mean age 62.9). Stenotic vessels treated included the internal carotid artery(n=18), middle cerebral artery(n=13), basilar artery(n=15), vertebrobasilar junction(n=2), and vertebral artery(n=13). Failure of stent placement was the only identified intraoperative complications, occurring in 6.6% of procedures. Perioperative complications occurred in 6.6% of patients, and included myocardial infarction(n=1), TIA or stroke without in-stent thrombosis(n=1), TIA or stroke with in-stent thrombosis(n=2), and death(n=2). Mortality rate was 3.3% in the perioperative period. Follow-up data was available for 41(67.2%) patients, with a mean duration of 205 days after intervention. In this follow-up group, 9.8%(n=4) suffered delayed in-stent thrombosis, 3(7.3%) of which suffered new TIAs or stroke. There was 1(2.4%) delayed mortality related to pseudoaneurysm rupture at the site of the stent. Conclusion: We present the largest series of patients outside of SAMMPRIS to undergo Wingspan stenting for intracranial stenosis. Immediate and long-term follow-up data demonstrates the safety profile of the procedure with efficacy in preventing future strokes. Delayed in-stent thrombosis is the most common risk to observe in this patient population.

Treatment of intracranial arterial stenosis

Intracranial stenosis accounts for 8–10% of ischemic strokes in the USA. Treatment of intracranial stenosis with extracranial-to-intracranial bypass surgery was investigated as a therapy in the 1980s, but was shown to be no better than aspirin alone. The Warfarin vs Aspirin for Symptomatic Intracranial Disease study found a 12% per year risk of recurrent stroke for symptomatic lesions of 50% or higher, with the majority of strokes occurring in the first year. Warfarin was no better than aspirin in the prevention of recurrent stroke and had a higher risk of serious bleeding and death. Subgroup analysis showed that patients with the highest risk of recurrent stroke included those with 70% or more stenosis and/or recent symptoms and women. Angioplasty and stenting of intracranial stenosis have been undergoing rapid evolution in technology and are emerging as a promising therapy. Current treatment recommendations include antiplatelet agents, with consideration for angioplasty alone or angioplasty and stenting in cases refractory to medical therapy.

Angioplasty and stenting of intracranial stenosis

Angioplasty and stenting of intracranial stenosis

Angioplasty and stenting of intracranial stenosis

The review summarizes recent advances in angioplasty and stenting of intracranial atherosclerotic stenosis. Several single-center studies show that, with the technological advancements in device technology, intracranial stenting is feasible even in the distal internal carotid artery or middle cerebral artery. However, the clinical outcomes vary between moderate and high risk rates for morbidity and mortality. To date, the only prospective multi-center study that has been conducted is the SSYLVIA (Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries) study, which demonstrated stroke rates of 6.6% and 13.1% at 30 days and 1 year, respectively. A unique feature of this trial is the assessment of restenosis rates and their potential association with clinical symptoms and risks. A promising new concept for stent-assisted procedures in the intracranial vasculature is the use of self-expanding stents. The high flexibility of these stents makes them suitable for treatment of lesions of the distal internal carotid artery and middle cerebral artery that are either inaccessible or difficult to reach with a balloon-mounted stent. Additionally, these self-expanding stents may result in fewer traumas to the parent vessel and in reduced rates of iatrogenic complications and restenosis. Intracranial angioplasty with or without stenting is a promising treatment option. Patient selection, careful periprocedural medical management, and a highly skilled neuroendovascular surgeon are all required to perform the procedure with an acceptable risk. If stenting is to be shown to be a safe therapeutic alternative, prospective trials comparing stenting with optimal medical treatment need to be performed.

Angioplasty with Stenting for Intracranial Stenosis: Does It Work?

Intracranial atherosclerosis is a major cause of stroke and cerebral ischemia. Medical therapy has included antiplatelet and anticoagulant medications,