Early versus delayed stenting for intracranial atherosclerotic artery stenosis with ischemic stroke

Abstract

ObjectiveTo evaluate the clinical outcomes of early stenting (≤14 days) or late stenting (>14 days) in patients who underwent intracranial stent placement.MethodsPatients with ischemic stroke caused by 70–99% intracranial atherosclerotic stenosis combined with poor collaterals were enrolled. The early stenting group, who underwent stenting within 14 days of last ischemic symptoms, were compared with the late stenting group who underwent stenting >14 days from last ischemic symptom. The patients were treated either with a balloon-mounted stent or a self-expanding stent as determined by the operators following a guideline. The baseline characteristics and clinical outcomes were evaluated and compared.ResultsOne hundred and fifteen stroke patients were recruited into the study. Four patients (4/41) in the early stenting group and two patients (2/74) in the late stenting group were diagnosed with a cerebral vascular event associated with stenting within 3 days (p=0.184). In the long-term follow-up, eight patients in the early stenting group had restenosis ≥50%, which was higher than patients in the late stenting group (8/41 vs 4/74, p=0.018). The total rates of any ischemic stroke, transient ischemic attack, hemorrhagic stroke, and death in the early stenting group were higher than in the late stenting group (9/41 vs 6/74, p=0.035). The recurrence rate of ischemic stroke in the early stenting group was higher than in the late stenting group (5/41 vs 2/74, p=0.041).ConclusionsStent placement in the setting of ischemic stroke caused by intracranial artery stenosis within 14 days may confer a higher risk of long-time cerebral vascular events and lead to a higher risk of restenosis.Clinical trial registrationNCT01968122.

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

“…Stent placement for ICAS was inferior to the medical treatment group in the SAMMPRIS and VISITIT trials, but from Asia, where the prevalence of atherosclerotic cerebral artery stenosis is high, better results have been reported. [12][13][14] Although the effectiveness of angioplasty for this disease is not yet clear, the most significant point is to select appropriate patients and reduce complications to enhance the therapeutic effect. Patients with hypoperfusion stroke secondary to ICAS who continue to have symptoms despite double antiplatelet therapy, statins, and tight control of hypertension and diabetes mellitus will be a good indication for angioplasty or stenting.…”

A Retrospective Study Comparison Between Stenting and Standardized Medical Treatment for Intracranial Vertebrobasilar Stenosis in a Real-World Chinese Cohort

“…This may be one of the reasons for the lower rate of complications in the PTAS group. A study showed that patients with delayed (> 14 days) ICAS stenting had a lower risk of longterm cerebral vascular events than those in whom the procedure was carried out < 14 days of the qualifying event (20). Although there was no significant difference in stroke rates from the 1st to 12th month between the SMT (9/62, 14.5%) and PTAS groups (13/174, 7.5%), there was a significant difference in the rate of severe stroke between the PTAS (0%) and SMT groups (9.7%).…”

Thirty-Day and One-Year Outcomes of Endovascular Treatments for Severe Atherosclerotic Stenosis of Intracranial ICA: Results From a Single Center

“…DSA was performed for all patients, and the strategy of endovascular treatment was decided according to the site and characteristics of the target lesions and based on the operators' experience and preference ( 3 , 9 ). In general, Apollo BMS (MicroPort Medical, Shanghai, China) was preferred in lesions with straightforward arterial access.…”

“…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 ). The annual risk of recurrent stroke in patients with ICAS varies from 4 to 40% and is especially high in patients with severe stenosis (70–99%), for which the rate is ~23% despite best medical therapy (BMT) ( 3 , 4 ). Endovascular treatments, including percutaneous transluminal angioplasty (PTA) with balloon dilatation (BD) alone and PTA with stenting (PTAS) using either a balloon-mounted stent (BMS) or a self-expanding stent (SES) have been developed and widely used in some countries.…”

“…One of the major concerns about the SAMMPRIS and VISSIT trials is that only one type of stent was used in each trial. However, different lesions are suitable for different treatments, and selecting either a BMS or SES based on the characterization of lesions might achieve a better clinical result ( 3 , 9 ). In addition, the clinical outcome of endovascular treatment is also associated with the location of arteries ( 10 ).…”