Primary Angioplasty without Stenting for Symptomatic, High-Grade Intracranial Stenosis with Poor Circulation

Wang, Y.; Ma, Yan; Gao, Peng; Chen, Y.; Yang, Bin

doi:10.3174/ajnr.a5708

Cited by 8 publications

(13 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the 19 eligible studies, only two were multicenter 3 4 6 8 12–26. Fourteen (73.7%) studies were retrospective (702 patients) and 5 (26.3%) were prospective (75 patients) (table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Although AMT is the preferred treatment in patients with symptomatic ICAD, those with poor anterograde circulation combined with severe stenosis are at high risk for future brain ischemic events and of becoming refractory to medical treatment 8. The primary drawbacks of alternative treatments, including stenting and primary angioplasty alone, are challenging navigation through tortuous arteries and iatrogenic arterial dissection 8. Moreover, stenting is commonly associated with arterial wall injury and intimal hyperplasia, which might lead to distal embolization and consequent periprocedural perforator stroke, as seen in SAMMPRIS 26.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, stenting is commonly associated with arterial wall injury and intimal hyperplasia, which might lead to distal embolization and consequent periprocedural perforator stroke, as seen in SAMMPRIS 26. Complete flow restoration following primary angioplasty is also associated with increased risk of dissection and ICH due to hyperperfusion syndrome, caused by an abrupt increase in blood flow and slow recovery of the vessel lumen 8. Therefore, evaluating an alternative solution such as SA is warranted to achieve efficacy greater than AMT, while minimizing the safety concerns associated with interventional procedures to date.…”

Section: Discussionmentioning

confidence: 99%

“…Although inconclusive, it seems likely that the lower incidence of perioperative complications, cerebrovascular events, and mortality in patients who were treated with SA rather than stenting and/or angioplasty alone can be attributed to its partial but adequate augmentation of blood flow to the brain, which may decrease the risk of hyperperfusion-related intracerebral hemorrhage,8 while retaining beneficial effects in patients with distal hypoperfusion at risk for recurrent stroke 26. Another benefit of SA is its ability to limit vessel wall damage, which possibly reduces the risk of plaque trauma, dissection or perforation, distal embolization, and perforator vessel occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, even a 10% increase in diameter can result in a 46% increase in blood flow while a 20% increase in diameter will result in a greater than 200% increase in blood flow. The addition of maximum medical therapy to SA can then help to promote plaque remodeling and sustain the increase in lumen 3 4 6–8…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Submaximal angioplasty in the treatment of patients with symptomatic ICAD: a systematic review and meta-analysis

Seyedsaadat

Yolcu

Neuhaus

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

IntroductionManagement approaches for intracranial atherosclerosis include medical, surgical, or endovascular treatment. Among endovascular treatments, recent studies have stated that submaximal angioplasty (SA) may offer considerable benefits and be a promising alternative to aggressive medical therapyand/or stenting in the treatment of intracranial atherosclerotic disease (ICAD).ObjectiveTo investigate the rates of periprocedural and long-term cerebrovascular accidents, mortality, and restenosis in patients with symptomatic ICAD who were treated with SA.MethodsAn electronic database search was performed for relevant studies that reported clinical outcomes of patients with ICAD following SA. Outcomes of interest were incidence of transient ischemic attack, intracerebral hemorrhage, stroke, and mortality in the periprocedural period and at 1 year. The periprocedural period was defined as the time from SA until 30 days after the procedure. Technical success and restenosis rates after the procedure were also analyzed.ResultsA total of 19 studies with 777 patients were identified. The technical success rate was 93% (95% CI 85% to 98%). The incidence of 30-day and 1-year stroke (all types) was 3% (95% CI 1% to 5%) and 5% (95% CI 4% to 8%), respectively. Thirty-day and 1-year mortality was found to be 1% (95% CI 0% to 2%) and 2% (95% CI 0% to 4%), respectively. The combined incidence of stroke or death was 5% (95% CI 3% to 8%) at 30 days, and 9% (95% CI 7% to 12%) at 1 year.ConclusionThe findings suggest that SA might be a promising alternative treatment in the treatment of symptomatic ICAD due to its favorable technical profile, periprocedural safety, and long-term efficacy. A randomized clinical trial is warranted to compare the safety and efficacy of SA with 'gold standard' medical treatment.

show abstract

“…Of the 19 eligible studies, only two were multicenter 3 4 6 8 12–26. Fourteen (73.7%) studies were retrospective (702 patients) and 5 (26.3%) were prospective (75 patients) (table 1).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Submaximal angioplasty in the treatment of patients with symptomatic ICAD: a systematic review and meta-analysis

Seyedsaadat

Yolcu

Neuhaus

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

Medical and Endovascular Treatments for Intracranial Atherosclerotic Stenosis: A Network Meta-Analysis

Peng

Wang

et al. 2021

Transl. Stroke Res.

View full text Add to dashboard Cite

Medical treatment and endovascular therapy are widely used for intracranial atherosclerotic stenosis, but the best treatment strategy remains uncertain. The goal of this study was to compare the safety and effectiveness of medical treatment, stenting, and primary balloon angioplasty (PBA). We searched PubMed, MEDLINE, and EMBASE for trials comparing these three treatments for intracranial stenosis up to December 24, 2020. We performed a network meta-analysis with randomeffects models. The primary outcome was any stroke or death during a long-term follow-up. Secondary outcomes included ischemic stroke, intracranial hemorrhage, and death. This network meta-analysis included 14 trials with 1520 participants. No significant difference was found between the three groups in the primary outcome, while PBA was probably the best treatment according to the ranking plot. Medical treatment had significantly lower rate of any stroke or death (odds ratio (OR), 0.31; 95% CI, 0.17-0.56), ischemic stroke (OR, 0.43; 95% CI, 0.23-0.81), and intracranial hemorrhage (OR, 0.12; 95% CI, 0.02-0.71) within 30 days than stenting but did not differ from PBA. The ranking plot demonstrated that PBA was also most likely to rank the highest for ischemic stroke during the long-term follow-up and beyond 30 days, although no significant difference was identified. Medical treatment had lower risk of any stroke or death within 30 days than stenting but did not differ from PBA. All the treatments had similar effects on the prevention of long-term stroke, while PBA had the highest probability of being the most effective.

show abstract

Effect of direct angioplasty therapy on acute middle cerebral artery occlusion with good leptomeningeal collateral

Luo

Huang²,

Yang

et al. 2020

Clinical Neurology and Neurosurgery

View full text Add to dashboard Cite

Primary Angioplasty without Stenting for Symptomatic, High-Grade Intracranial Stenosis with Poor Circulation

Abstract: In this retrospective series, primary balloon angioplasty was an effective treatment option for symptomatic intracranial stenosis with a high risk of stroke.

Cited by 8 publications

References 13 publications

Submaximal angioplasty in the treatment of patients with symptomatic ICAD: a systematic review and meta-analysis

Submaximal angioplasty in the treatment of patients with symptomatic ICAD: a systematic review and meta-analysis

Medical and Endovascular Treatments for Intracranial Atherosclerotic Stenosis: A Network Meta-Analysis

Effect of direct angioplasty therapy on acute middle cerebral artery occlusion with good leptomeningeal collateral

Contact Info

Product

Resources

About