Balloon-mounting stent for intracranial arterial stenosis: A comprehensive and comparative systematic review and meta-analysis

Abdollahifard, Saeed; Yousefi, Omid; Kamran, Hooman; Mowla, Ashkan

doi:10.1177/15910199221100620

Cited by 4 publications

(6 citation statements)

References 46 publications

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“…In-stent restenosis may occur, with the rate of restenosis ranging 2.38% to 26.7% at follow-up months after stenting. [11,13–18] In our study, the in-stent restenosis rate was 12.54% at a follow-up duration of 28 ± 6.7 months, with the symptomatic restenosis in 8 (22.22%) patients and non-symptomatic restenosis in other 28 (77.78%). Twenty-eight patients with restenosis did not have any symptoms probably because the restenosis was slowly built up and enabled sufficient collateral circulation to set up.…”

Section: Discussionmentioning

confidence: 48%

“…[9,10] Moreover, in-stent restenosis may occur after percutaneous transluminal angioplasty and stenting in patients with intracranial atherosclerotic stenosis, and postoperative in-stent restenosis has been reported to range 2.38% to 26.7% at follow-up months after stenting. [5,[11][12][13][14][15][16][17][18] Even though the SAMMPRIS study denied the association of high perioperative complications with the surgeons technical experience in stenting, [9,10] a previous study enrolling 433 patients [19] has revealed a significantly (P < .05) higher complication rate during the initial experience accumulation stage than the later technical maturation stage. Further analysis demonstrated that the incidences of hemorrhagic, thrombotic and fatal/disabling complications were closely associated with the surgeons experience levels and that the complication rates pertinent to surgical techniques exhibited an apparent learning curve, which was consistent with other studies.…”

Section: This Study Was Supported By Funding From the Key Randd Progr...mentioning

confidence: 99%

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Complications and long-term in-stent restenosis of endovascular treatment of severe symptomatic intracranial atherosclerotic stenosis and relevant risk factors

Yang,

Du,

Zhang

et al. 2023

Medicine

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To investigate the complications and in-stent restenosis of endovascular treatment of severe symptomatic intracranial atherosclerotic stenosis and relevant risk factors. Three hundred and fifty-four consecutive patients with intracranial atherosclerotic stenosis (70%–99%) were retrospectively enrolled. The clinical data, treatment outcomes, complications and in-stent restenosis at follow-up were analyzed. The endovascular treatment was composed of balloon dilatation only in 21 (5.93%) patients, and deployment of self-expandable stents in 232 (65.54%), balloon-expandable stents in 75 (21.19%), and both balloon- and self-expandable stents in 26 (7.34%), with a total of 359 stents being successfully deployed at the stenotic location. After treatment, the residual stenosis ranged 9.2%±1.5% (range 7%–19%), which was significantly (P < .05) smaller than that before treatment. Periprocedural complications occurred in 43 patients with a complication rate of 12.15% including arterial dissection in 4 (1.13%) patients, new cerebral infarction in 21 (5.93%), cerebral hemorrhage in 12 (3.3%), and subarachnoid hemorrhage in 6 (1.69%). Hyperlipidemia [odds ratio (OR) 10.35, 95% confidence interval (CI) 4.42–24.28, and P < .0001] and location at the middle cerebral artery (MCA) (OR 4.15, 95% CI 1.92–8.97, and P < .001) were significant (P < .05) risk factors for periprocedural complications, whereas hyperlipidemia (OR 11.28, 95% CI 4.65–30.60, and P < .0001), location at the MCA (or 5.26, 95% CI 2.03–15.08, and P < .001), and angulation (OR 1.02, 95% CI 1.00–1.04, and P = .02) were significant (P < .05) independent risk factors for periprocedural complications. Follow-up was performed in 287 (81.07%) patients at 6 to 36 (28 ± 6.7) months. In-stent restenosis was present in 36 (12.54%), and female sex (OR 2.53, and 95% CI 1.27–5.06) and periprocedural complications (OR 9.18, and 95% CI 3.52–23.96) were significant (P < .05) risk factors for in-stent restenosis, with periprocedural complication (OR 9.61, and 95% CI 3.48–27.23) as the only significant (P < .0001) independent risk factor for in-stent restenosis. A certain rate of periprocedural complications and in-stent stenosis may occur in endovascular treatment of severe intracranial stenosis, and the relevant risk factors may include hyperlipidemia, MCA location, angulation at the stenosis and female sex.

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Section: Discussionmentioning

confidence: 48%

Section: This Study Was Supported By Funding From the Key Randd Progr...mentioning

confidence: 99%

Complications and long-term in-stent restenosis of endovascular treatment of severe symptomatic intracranial atherosclerotic stenosis and relevant risk factors

Yang,

Du,

Zhang

et al. 2023

Medicine

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“…Recent meta-analysis studies showed that: compared to SES, BMS was more effective in reducing the degree of stenosis (Difference in mean −5.953, CI 95% −7.727 to −4.179), and has lower rates of complications (8.5% vs. 11.2%) and ISR (18.6% vs. 19.6%), but higher rate of all-cause mortality (1.7% vs. 4.1%) in treating sICAS 38 ; PTBA offers the highest level of safety outcomes in terms of short-term mortality or stroke, compared to SES (OR = 2.50; 95% CI 1.12 to 5.57; p = 0.026) and BMS (OR = 0.43; 95% CI 0.19 to 0.96; p = 0.038). 39 Even so, these results needs to be confirmed in future studies, and the optimal strategy of procedure for sICAS has not yet been determined.…”

Section: Discussionmentioning

confidence: 95%

Short-term outcome of stenting with Enterprise stents for symptomatic intracranial atherosclerotic disease at a single center

Zhou

et al. 2022

Interv Neuroradiol

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Objective To evaluate the safety and efficacy of stenting for symptomatic intracranial atherosclerotic severe stenosis or occlusion with Enterprise stents. Methods Fifty-three consecutive patients with symptomatic intracranial atherosclerotic severe (70%–99%) stenosis or occlusion who underwent endovascular treatment with Enterprise stents between September 2019 and March 2022 were retrospectively analyzed. Primary outcomes included technical stenting success rates, the incidence of complications within 30 days of the procedure, and the in-stent restenosis rates during the follow-up period. These outcomes were further categorized based on lesion location and operation time. Results Fifty-seven lesions in 53 patients aged 61.0 ± 10.0 years were treated with Enterprise stents with a technical success rate of 100%. Seven patients (12.3%) had severe complications within 30 days of the procedure: five had a symptomatic ischemic stroke, one had a symptomatic intracerebral hemorrhage, and one had a subarachnoid hemorrhage related to the procedure. No deaths were observed. The rate of in-stent restenosis was 18.2%, with a mean vascular imaging follow-up period of 6.7 months. The 30-day complication and in-stent restenosis rates did not differ significantly between patients with different lesion locations and operation times ( P > 0.05). Conclusion This retrospective study suggests that percutaneous transluminal angioplasty and stenting with Enterprise stents is an effective treatment for symptomatic intracranial arterial stenosis or occlusion with a high technical success rate. It also indicates that stenting during the early nonacute stage after stroke may not increase the incidence of perioperative complications for symptomatic intracranial atherosclerotic stenosis when following strict inclusion criteria.

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“…The Vitesse is a BES that is limited as an investigational device in the US [33]. However, previous studies have reported that intracranial stenting with a BES is more effective in reducing the degree of stenosis and has a lower complication rate than a Wingspan stent [34][35][36]. This rather contradictory result may be due to several potential explanations.…”

Section: Discussionmentioning

confidence: 99%

Comparative effect of stenting plus medical therapy vs medical therapy alone on the risk of stroke and death in patients with symptomatic intracranial stenosis: a systematic review and meta-analysis

Wang

et al. 2022

J Neurol

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Background Recently, several randomized controlled trials (RCTs) of stenting plus medical therapy versus medical therapy alone have been successfully conducted for the treatment of patients with symptomatic intracranial stenosis. This study aimed to evaluate differences between these two therapies in the risk of stroke and death. Methods MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov were systematically searched to identify relevant studies published before August 24, 2022. Review Manager 5.3 software was used to assess the data. The risk ratio (RR) was analysed and calculated with a random effect model or a fixed effects model. Results We pooled 921 participants from three RCTs. Compared to the medical therapy alone group, the stenting plus medical therapy group had a higher risk of 30-day death or stroke (RR = 2.69 [1.64–4.41], P < 0.0001, I2 = 0%). When the follow-up period exceeded 1 year (≥ 1 year), there was no significant difference in the risk of stroke or death between these two groups. The subgroup analysis showed that if the time from stroke onset to implantation was extended, additional stenting would have no effect on the risk of stroke or death, whether within 30 days or within 1 year (P = 0.16 and 0.78). Conclusion Medical therapy alone has a lower risk of stroke and death in the short term than stenting plus medical therapy, while no difference exists in the long term. More studies are still needed to further explore the precision strategy of stent implantation for symptomatic intracranial stenosis patients.

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Balloon-mounting stent for intracranial arterial stenosis: A comprehensive and comparative systematic review and meta-analysis

Cited by 4 publications

References 46 publications

Complications and long-term in-stent restenosis of endovascular treatment of severe symptomatic intracranial atherosclerotic stenosis and relevant risk factors

Complications and long-term in-stent restenosis of endovascular treatment of severe symptomatic intracranial atherosclerotic stenosis and relevant risk factors

Short-term outcome of stenting with Enterprise stents for symptomatic intracranial atherosclerotic disease at a single center

Comparative effect of stenting plus medical therapy vs medical therapy alone on the risk of stroke and death in patients with symptomatic intracranial stenosis: a systematic review and meta-analysis

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