Primary stent therapy for symptomatic intracranial atherosclerotic stenosis: 1-year follow-up angiographic and midterm clinical outcomes

Abstract

Elective stent surgery can provide good angiographic and clinical midterm outcomes in patients with symptomatic intracranial atherosclerotic stenosis, and the procedure is associated with a high degree of technical success. Reassessment of these promising results is needed in a larger population and in a randomized prospective comparison study.

The NIH registry on use of the Wingspan stent for symptomatic70–99% intracranial arterial stenosis

“…16,17,[19][20][21][22][23][24][25]27 In a report of 59 patients treated with drug-eluting balloon-mounted coronary stents, 50% of the patients had lesions in the extracranial vertebral artery, 8% were in the intracranial internal carotid artery, and none were in middle cerebral artery, reflecting the difficulty in tracking the coronary stents into the intracranial circulation.34…”

“…Intracranial angioplasty is an option, however, it has largely been replaced by stenting because of the technical drawbacks associated with angioplasty including immediate elastic recoil of the artery, dissection, acute vessel closure, residual stenosis >50% following the procedure, and high restenosis rates.11-15 Intracranial stenting has emerged as the preferred technique by most interventionalists and is increasingly being used in the United States and other countries. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] Most of the experience with intracranial stenting has been with balloon mounted coronary stents but these stents are difficult to deliver in the tortuous intracranial circulation. In August 2005, the Food and Drug Administration (FDA) granted a Humanitarian Device Exemption (HDE) approval for a self-expanding nitinol intracranial stent (the Wingspan stent, Boston Scientific, Fremont, CA) for use in patients with ≥50% intracranial stenosis who have recurrent ischemic events while on antithrombotic therapy.…”

Perioperative management of a neurosurgical patient requiring antiplatelet therapy

“…6 Consensus statements agree that there is a high risk of thrombosis for bare metal coronary stents within eight weeks of implantation. 10,11 In a oneyear follow-up study, 10 patients with symptomatic intracranial atherosclerotic arteries (>60% stenosis) treated by stent placement and maintained on clopidogrel for six months and aspirin indefinitely did not demonstrate re-stenosis (>50%) or ischemic events. Consequently, dual antiplatelet therapy is continued for at least six months to allow the stent to endothelialize.…”

Long term clinical and angiographic outcomes with the Wingspan stent for treatment of symptomatic 50–99% intracranial atherosclerosis: single center experience in 51 cases

“…9 10 The high rate of neurological events on medical therapy has lead to an renewed interest in intracranial stenting as an alternative therapeutic option. 11 12 13 14 15 16 17 18 19 20 21 22 …”