Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis

Gao, Peng; Wang, D.; Zhao, Zhenwei; Cai, Yuyang; Li, T.; Shi, Huaizhang; Wu, Wei; He, Wei; Yin, Long; Huang, Shiying; Zhu, Feiqi; Jiao, Liqun; Ji, Xunming; Qureshi, Adnan I.; Li, Feng

doi:10.3174/ajnr.a4698

Cited by 63 publications

(71 citation statements)

References 29 publications

(34 reference statements)

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“…Thus our results are promising but also underline the periprocedural risk of eICS. Previous studies of the post-SAMMPRIS era, mostly investigating eICS for ICAD in Asian populations, reported low rates of death and stroke recurrence on day 30, ranging from 2.8% to 4.4% 10 12–14. However, these promising results might not be applicable to western populations because of the ethnic component of ICAD,risk factors, incidences, and comorbidities of symptomatic intracranial stenosis possibly differ and therefore outcome results might require a different interpretation 15.…”

Section: Discussionmentioning

confidence: 99%

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

Meyer

Leischner

Thomalla

et al. 2020

J NeuroIntervent Surg

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Background and purposeStroke recurrence is high in patients with symptomatic intracranial stenosis despite best medical treatment. Based on evidence from past studies using previous stent generations, elective intracranial stenting (eICS) is considered in a minority of patients. This study aims to report on experience performing eICS with a novel device combination.MethodsWe retrospectively reviewed data from three high volume stroke centers and analyzed patients that were treated with eICS for symptomatic intracranial stenosis using the Acclino® (flex) stent and the NeuroSpeed® balloon catheter (Acandis GmbH, Pforzheim, Germany). Study endpoints were periprocedural rates of stroke regardless of territory or death at discharge and at the time of follow-up after eICS. Safety evaluation included asymptomatic and symptomatic intracranial hemorrhage, serious adverse events related to the intervention, and evaluation of stent patency at the time of follow-up.ResultsThe median age of patients that met the inclusion criteria (n=76) was 69 years. Target vessels were located in the anterior circulation in 55.3% (42/76) of patients. The periprocedural stroke rate was 6.5% (fatal stroke 2.6%; non-fatal stroke 3.9%) at discharge after eICS. Asymptomatic intracranial hemorrhage was observed in 5.2% (4/76) of patients. Follow-up DSA revealed in-stent restenosis of 25% (15/60), and percutaneous transluminal angioplasty was performed again in 11.6% (7/60) of patients.ConclusionStenting for symptomatic intracranial stenosis with the Acclino® (flex)/NeuroSpeed balloon® catheter seemed to be safe and reinforces eICS as an endovascular therapy option for secondary stroke prevention. Future studies are warranted to confirm these findings and investigate antithrombotic strategies and in-stent restenosis to minimize periprocedural complications and guarantee long term stent patency.

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Section: Discussionmentioning

confidence: 99%

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

Meyer

Leischner

Thomalla

et al. 2020

J NeuroIntervent Surg

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“…Gao et al enrolled patients with recent TIA or ischemic stroke related to high-grade stenosis of a major intracranial artery and with distal hypoperfusion and/or cortical involvement but excluded patients who had ischemic symptoms within the recent 3 weeks and perforator ischemic events. As a result, the overall 1-month stroke and/or death rate was 2% (2/100) [23]. Characteristics of the above trails were summarized in Table 2.…”

Section: Discussionmentioning

confidence: 99%

Current Status and Future Perspective of Stenting for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis

Zhou

Zhu

et al. 2017

BioMed Research International

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The aim of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty and stenting (PTAS) for intracranial atherosclerotic disease (ICAD) by conducting a meta-analysis. Two independent observers searched PubMed, EMBASE, and Cochrane Library for relevant studies up to 31 December 2016. A meta-analysis was conducted using Review Manager 5.3. Three studies involving 581 cases were included. The meta-analysis indicated that any stroke (RR = 3.13; 95% CI: 1.80–5.42), ischemic stroke (RR = 2.15; 95% CI: 1.19–3.89), and intracranial hemorrhage (RR = 14.71; 95% CI: 1.96–110.48) within 30 days in medical therapy alone were lower compared with PTAS plus medical therapy, but there were no significant differences in any stroke and ischemic stroke beyond 30 days between the two groups. There were also no significant differences in any death and myocardial infarction between the two groups. This meta-analysis demonstrated that, compared with medical therapy alone, PTAS for ICAD had a high risk of complication, but most complications in PTAS group occurred within 30 days after the operation, and beyond 30 days the PTAS was not inferior compared with medical therapy alone. Further studies are needed to reduce the periprocedural complications and reappraise the PTAS.

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“…Patients with ischemic symptoms related to high-grade intracranial stenosis (70-99%) have an almost 20% risk of recurrent stroke within one year despite antithrombotic treatment [1]. Studies demonstrate that in the setting of maximal medical therapy, a large cohort of patients will remain symptomatic [2].…”

Section: Introductionmentioning

confidence: 99%

Tandem Short-length Multi-stent Construct for Emergent Revascularization of Occlusive Long-segment Left Middle Cerebral Artery In-stent Stenosis

Karsonovich

Bolt²,

Gordhan

2020

Cureus

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Endovascular stenting and balloon angioplasty is a feasible although controversial option for intracranial atherosclerotic stenosis refractory to maximize medical management. High rates of symptomatic in-stent restenosis (ISR) have been identified with Wingspan stent (Stryker, Fremont, CA, USA) placement. Revascularization of ISR by way of re-stenting is often attempted, albeit with high risk and low durability. In lesions with long-segment non-focal critical or emergent occluded stenosis, re-stenting with a single balloon mounted stent is not possible due to deliverability of a lengthy device through a tortuous carotid siphon. Tandem drug-eluting stent placement within the middle cerebral artery to address acute, occlusive ISR using a Wingspan stent, with additional stent reconstruction, has not been previously described.

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Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis

Cited by 63 publications

References 29 publications

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

Current Status and Future Perspective of Stenting for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis

Tandem Short-length Multi-stent Construct for Emergent Revascularization of Occlusive Long-segment Left Middle Cerebral Artery In-stent Stenosis

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