Complication rates using balloon-expandable and self-expanding stents for the treatment of intracranial atherosclerotic stenoses

Abstract

Data of the INTRASTENT registry do not support the hypothesis that introduction of SES lowered the overall complication rate of intracranial stent procedures. There might be an advantage using self-expanding stents in vessel segments with important perforating arteries.

Is There a Future for Endovascular Treatment of Intracranial Atherosclerotic Disease After Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis (SAMMPRIS)?

“…30 However, recent publications have suggested that the complication rates with balloon-expandable stents are similar to those seen with self-expanding stents such as Wingspan. 31,32 Favorable rates of ipsilateral stroke beyond the 30-day period have also been reported for both angioplasty alone and for balloon-expandable stents. 23,26,27 However, these are all retrospective reports and the patients have not had the closer scrutiny of a randomized trial.…”

Elective treatment of intracranial stenosis with the balloon-expandable Pharos Vitesse stent: 30-day stroke rate and complications

“…Blasel et al 25 used BES in patients with >50% stenosis, with a 95% technical success rate and a 7.5% complication rate. Analysis of the multicentric INTRASTENT registry showed a rate of disabling stroke or death in 7.0% of the stent placements, with no clear significant differences between SES and BES (10.0% vs 4.5%, p=0.054) 26 27. The drawbacks of all these studies are lack of randomization, retrospective design, and a relatively small number of patients included.…”

Analysis of periinterventional complications of intracranial angioplasty and stenting: A single center experience

“…This technique is faster and less prone to induce distal vessel perforation. In contrast, perforator occlusion appears to be more common in balloon-expanding than in self-expanding stents, and self-expanding stents may thus be advantageous in vessel segments with important perforating arteries [18,19]. Passage of the distal internal carotid artery with the more rigid balloon expanding stents can be difficult particularly in patients with a narrow and rigid siphon [19].…”

“…In contrast, perforator occlusion appears to be more common in balloon-expanding than in self-expanding stents, and self-expanding stents may thus be advantageous in vessel segments with important perforating arteries [18,19]. Passage of the distal internal carotid artery with the more rigid balloon expanding stents can be difficult particularly in patients with a narrow and rigid siphon [19]. These limitations of balloon expanding stents were at least in part resolved by the development of very flexible, balloon-mounted coronary stents, which are employed in off-label use in cerebrovascular interventions [19].…”

“…Passage of the distal internal carotid artery with the more rigid balloon expanding stents can be difficult particularly in patients with a narrow and rigid siphon [19]. These limitations of balloon expanding stents were at least in part resolved by the development of very flexible, balloon-mounted coronary stents, which are employed in off-label use in cerebrovascular interventions [19].…”