Role of Balloon-Expandable Stents in Intracranial Atherosclerotic Disease in a Series of 182 Patients

Abstract

Treatment of intracranial atherosclerotic disease with balloon-expandable intracranial stents is a safe and effective method with acceptable adverse events, especially in patients who failed medical therapy and were symptomatic despite being on optimum medical therapy.

Stenting of symptomatic intracranial stenosis using balloon mounted coronary stents: a single center experience

“…Our overall morbidity of 9.5% with an average clinical follow-up time of 32.1±24.5 months is similar to the average reported overall morbidity of 8.8% in 282 patients (range 7–9.8%) reported in the literature 11 15. The overall morbidity following Wingspan placement was 19.4% in 431 patients (range 7.1–23%), as reported in the literature 2 12 14 16.…”

“…Other studies of BMCS deployment across intracranial stenoses have reported similar results, with an average periprocedural morbidity of 7.4% in 339 patients (range 5.6–22.7%) 3 10 11. Reported periprocedural morbidity rates following Wingspan use may be higher, with an average periprocedural morbidity of 9.9% in 497 patients (range 4.4–14.7%), including a 14.7% periprocedural morbidity rate following Wingspan deployment in the SAMMPRIS trial 2 12–14.…”

“…As a comparison, patients in the SAMMPRIS trial who were treated with aggressive medical therapy continued to have strokes well beyond the 30 day time period. The probability of a stroke at 1 year in patients treated with aggressive medical therapy alone was 12.2%,2 which is higher than the reported long term morbidity following BMCS placement 11 15. In the recently published final results of the SAMMPRIS trial, the authors cite a 15% overall morbidity in the medical treatment arm over a median follow-up of 32.4 months 8.…”

Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials

“…The use of balloon-expandable intracranial stents for high-grade symptomatic atherosclerotic stenosis was successful and relatively safe in a report from India. 50 A randomized clinical trial on balloon-expandable stent for symptomatic intracranial stenosis was unsuccessful; the stent use increased stroke risk compared with medical therapy. 51 The efficacy of intracranial stenting in reopening acute local thrombo-occlusion because of underlying atherosclerosis needs further investigation.…”

Incidence and Risk Factors for Diffusion-Weighted Imaging (+) Lesions After Intracranial Stenting and Its Relationship With Symptomatic Ischemic Complications

“…15,16 Intracranial stenting has been suggested as an adjuvant or a rescue treatment modality for patients who are refractory to medical management. [17][18][19] Nonetheless, there has been only one small case series investigating DWI (+) after intracranial stenting. 4 In this study, we evaluated the incidence, distribution, and risk factors of DWI (+) after intracranial stenting and its relationship to symptomatic ischemic complications (SIC).…”