Concurrent Comparison of Outcomes of Primary Angioplasty and of Stent Placement in High-Risk Patients With Symptomatic Intracranial Stenosis

Qureshi, Adnan I.; Hussein, Haitham M.; El-Gengaihy, A; Abdelmoula, M.; Suri, M. Fareed K.

doi:10.1227/01.neu.0000325867.06764.3a

Cited by 41 publications

(23 citation statements)

References 25 publications

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“…Patient selection for endovascular therapy is often based on imaging findings, failure of “best medical therapy”, timing of the ischemic event and clinical significance of the stenosis 16. In this study, the qualifying event for endovascular treatment in the PTAS group was more likely a TIA, despite medical therapy, suggesting that the decision to intervene was based on symptom recurrence in healthier patients often electively referred from an outpatient setting.…”

Section: Discussionmentioning

confidence: 82%

Outcome of Symptomatic Intracranial Atherosclerotic Disease

Samaniego

Hetzel²,

Thirunarayanan³

et al. 2009

Stroke

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Background and Purpose Patients with intracranial atherosclerotic disease (ICAD) have a 3.6% to 22% annual risk of stroke. In this study, we sought to evaluate the natural history and prognosis of patients with symptomatic ICAD who received medical therapy versus percutaneous transluminal angioplasty and stenting (PTAS) at our institution. Methods Charts of all patients with symptomatic ICAD from July 2004 to September 2007 were reviewed and assessed for history of transient ischemic attack (TIA) or stroke. Patients were either treated with “best medical therapy” (Medical Therapy Group) or PTAS plus antiplatelet agents (PTAS Group), and followed prospectively. A favorable outcome was defined as the absence of TIAs, strokes or vascular death, modified Rankin Scale of 3 or less and no endovascular re-intervention of symptomatic in-stent restenosis (ISR). Results One hundred eleven patients fulfilled entry criteria, with 58 (52.3%) and 53 patients (47.7%) enrolled in the Medical Therapy and PTAS Groups, respectively. Thirty-eight patients of the Medical Therapy group (65.5%) had a favorable outcome compared to 37 patients of the PTAS group (69.8%). Combined ischemic endpoint data for the occurrence of TIA, stroke and vascular death was similar with 14 (24%) events in the Medical Therapy group versus 15 (28.3%) events in the PTAS group. Conclusion Overall, the combined ischemic endpoint was the same in the Medical Therapy and PTAS groups.

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Section: Discussionmentioning

confidence: 82%

Outcome of Symptomatic Intracranial Atherosclerotic Disease

Samaniego

Hetzel²,

Thirunarayanan³

et al. 2009

Stroke

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“…(2) In contrast to the sole Wingspan stent, we chose treatment options including BMS, SES, and primary angioplasty. Patient with small vessels, long lesion, and full perforating branches of lesion were tend to be treated with primary angioplasty, as this may be safer for such complex lesions . In addition, the SES has procedural disadvantage compare to primary angioplasty and BMS, which requires a 2‐step procedures involving angioplasty followed by removal of the angioplasty microcatheter, maintenance of a long exchange wire across the stenosis, and placement of the SES.…”

Section: Discussionmentioning

confidence: 99%

Learning curve for intracranial angioplasty and stenting in single center

Cai

Sun

et al. 2013

Cathet Cardio Intervent

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“…A large series with balloon angioplasty alone proved reasonable clinical outcomes with an acute complication rate of 5.8% and a neurologic event rate of 3.2% per year [16]. A nonrandomized comparative study showed no significant differences in clinical outcomes [17]. Similar to other vascular territories the main disadvantage of balloon angioplasty is the unpredictable angiographic result with a major proportion of suboptimal results with major residual stenosis due to elastic recoil or dissection.…”

Section: Data From Intracranial Stent Studiesmentioning

confidence: 91%

Intracranial Stenting of Atherosclerotic Stenoses*

Berkefeld

Zanella

2009

Clin Neuroradiol

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The purpose of this review article is to give an overview of the current development of intracranial stenting for treatment of atherosclerotic stenoses. Natural history and methods for diagnostic imaging are described as basis for the indication for endovascular treatment. Target group are patients with high-grade symptomatic stenoses > 70%. Technical standards for the use of self-expanding and balloon-expandable stents are reported together with the results of clinical case series. It seems to be difficult to drop acute complication rates (procedure-related stroke and death during the first 30 days) reliably from current levels of around 10% to values < 6%, which are more acceptable for a prophylactic procedure for the prevention of stroke. High restenosis rates up to 30% in the 1st year raised concerns about long-term efficacy. Further technical developments and improved criteria for patient selection are necessary to make intracranial stenting safer and more effective before a randomized trial (stent vs. medical treatment) may prove superiority of the endovascular approach.

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Concurrent Comparison of Outcomes of Primary Angioplasty and of Stent Placement in High-Risk Patients With Symptomatic Intracranial Stenosis

Cited by 41 publications

References 25 publications

Outcome of Symptomatic Intracranial Atherosclerotic Disease

Outcome of Symptomatic Intracranial Atherosclerotic Disease

Learning curve for intracranial angioplasty and stenting in single center

Intracranial Stenting of Atherosclerotic Stenoses*

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