Intracranial Angioplasty and Stenting before and after SAMMPRIS: “From Simple to Complex Strategy – The Chinese Experience”

Abstract

Intracranial atherosclerotic disease (ICAD) accounts for 33–50% of all ischemic strokes in the Asian population (1) and represents an important public health issue in China. The results of the SAMMPRIS trial alarmed most experienced interventionalists in China for two reasons. Firstly, the high complication rate in the stenting arm (20% the first year) was higher than expected. Secondly, the recurrent stroke rate in the aggressive medical treatment arm at 12.2% during the first year was unacceptably high, not to mention the fact that such tight vascular risk factor control is difficult to achieve for many patients in real life clinical experience, at least in China. The experience of treating ICAD in China, gained over the last two decades, is very rich and promising. We intend to highlight these past experiences and address future trials and trends in China. We will also address our criticism of the SAMMPRIS trial design in order to better design a future trial.

Combined Use of Mechanical Thrombectomy with Angioplasty and Stenting for Acute Basilar Occlusions with Underlying Severe Intracranial Vertebrobasilar Stenosis: Preliminary Experience from a Single Chinese Center

“…15 However, there have been controversies over the study; with improved patient and device selection and increased technical experience, intracranial stent placement still holds a promising role for selected patients. 8,20,21 The use of the Wingspan stent was not off-label in our center. Our choice of endovascular devices was based on lesion or vessel characteristics 8 ; hence, we advise caution against overinterpretation of our data because our study was not meant to compare the efficacy among different vascularization methods by using the Apollo, the Wingspan stent, or sole angioplasty.…”

Thirty-Day Outcome of a Multicenter Registry Study of Stenting for Symptomatic Intracranial Artery Stenosis in China

“…16 Nonetheless, the weight of these studies do not compare with that of randomized clinical trials. 17 A randomized clinical trial with careful selection of patients is thus warranted in the Chinese population such that these patients are not deprived of a potentially beneficial treatment.…”

Optical coherence tomography evaluation of vertebrobasilar artery stenosis: case series and literature review

“…Stenting can improve cerebral perfusion to alleviate ischemic symptoms and compress the plaque outside the stent to prevent the embolus from falling and causing cerebral infarction. However, endovascular interventions may cause periprocedural complications, such as wall dissection and occlusion of perforating branches 25. So accurate assessment of the artery stenotic histopathologic findings may help in the selection of suitable patients for interventional therapy and reduce the risk of periprocedural complications.…”