Reporting Standards for Angioplasty and Stent-Assisted Angioplasty for Intracranial Atherosclerosis

Abstract

Background and Purpose-Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients.Technological advances over the past 10 years have enabled endovascular treatment of intracranial atherosclerotic stenosis. The number of patients treated with angioplasty or stent-assisted angioplasty for this condition is increasing. Given the lack of universally accepted definitions, the goal of this document is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting clinical and radiological evaluation, technique, and outcome of endovascular treatment using angioplasty or stent-assisted angioplasty for stenotic and occlusive intracranial atherosclerosis. (PubMed) from January 1997 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data in stenotic intracranial atherosclerosis that could be used as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This document offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of intracranial stenotic and occlusive atherosclerosis. Included in this guidance document are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should also be helpful in clinical practice and applicable to all publications. Conclusion-In summary, the definitions proposed represent recommendations for constructing useful research data sets. Summary of Report-ThisThe intent is to facilitate production of scientifically rigorous results capable of reliable comparisons between and among similar studies. In some cases, the definitions contained here are recommended by consensus of a panel of experts in this writing group for consistency in reporting and publication. These definitions should allow different groups to publish results that are directly comparable. (Stroke. 2009;40:e348-e365.)Key Words: anatomy Ⅲ angiography Ⅲ interventional neuroradiology Ⅲ neuroradiology Ⅲ reporting standard Ⅲ reporting terminology Ⅲ stenting T he goal of this writing group is to provide consensus recommendations for the arteriographic evaluation and endovascular treatment of intracranial atherosclerosis. These criteria are aimed to design clinical trials, to provide uniformity of definitions for appropriate selection and stratification of patients, and to allow analysis and meta-analysis of reported data. This document must not be construed as defining standardof-care. However, these reporting standards are intended for use in research protocols rather than for quality assessment in individual practice. These definitions represent one set of consensus recommendations for constructing useful research data sets. These definitions do not represent the only data that are important or useful i...

Impact of Target Arterial Residual Stenosis on Outcome After Endovascular Revascularization

“…10 Recanalization and reperfusion status was measured using AOL and mTICI scales, 10 and if the TAL showed residual stenosis on final post-procedural angiography (AOL grade 2), the degree of stenosis was measured by the Warfarin-Aspirin Symptomatic Intracranial Disease Study (WASID) method. 15 The degree of stenosis was classified as mild (<50%), moderate (50–69%), and severe (70–99%). Further, the degree of stenosis on follow-up (5–7 days) angiographic images were categorized as normal, mild (signal reduction <50%), moderate (signal reduction ≥50%), severe (focal signal loss with the presence of distal flow), and occlusion (sudden cutoff without distal flow void) using MR angiography (MRA; n=151;92.6%).…”

High-Grade Internal Carotid Artery Stenosis and Chronic Brain Damage: A Volumetric Magnetic Resonance Imaging Study

“…Repair of an extracranial high-grade stenosis of the internal carotid artery (ICA) following ipsilateral stroke or a transient cerebral ischemic attack is a recommended procedure to prevent stroke recurrence [1,2]. What to do in case of an asymptomatic high-grade stenosis is much less clear [3].…”

Safety of Low-Dose Aspirin in Endovascular Treatment for Intracranial Atherosclerotic Stenosis

“…The dose of each antiplatelet agent varies from operator to operator, and there is no consensus on the safety, dosage, or drug combination [11], [12], [13]. Particularly, the dose of aspirin varies greatly worldwide and it is given between 81 and 325 mg daily before the procedure [10]. This variation in practice is partly due to the fact that no comparisons of aspirin dose have been done in intracranial endovascular treatment since its routine use a decade ago.…”

“…Despite its universal use, the optimal dose of aspirin from an efficacy and safety perspective remains unclear [9], [10]. Based on the studies for patients who underwent percutaneous coronary intervention, high-dose aspirin (≥300 mg daily) did not differ significantly from low-dose aspirin (75–100 mg daily) in prevention of cardiovascular death, myocardial infarction, or stroke, and stent thrombosis [11], [12], [13].…”