Safety and efficacy of balloon-mounted stent in the treatment of symptomatic intracranial atherosclerotic disease: a multicenter experience

Abstract

BackgroundRandomized clinical trials have failed to prove that the safety and efficacy of endovascular treatment for symptomatic intracranial atherosclerotic disease (ICAD) is better than that of medical management. A recent study using a self-expandable stent showed acceptable lower rates of periprocedural complications.ObjectiveTo study the safety and efficacy of a balloon-mounted stent (BMS) in the treatment of symptomatic ICAD.MethodsProspectively maintained databases from 15 neuroendovascular centers between 2010 and 2020 were reviewed. Patients were included if they had severe symptomatic intracranial stenosis in the target artery, medical management had failed, and they underwent intracranial stenting with BMS after 24 hours of the qualifying event. The primary outcome was the occurrence of stroke and mortality within 72 hours after the procedure. Secondary outcomes were the occurrence of stroke, transient ischemic attacks (TIAs), and mortality on long-term follow-up.ResultsA total of 232 patients were eligible for the analysis (mean age 62.8 years, 34.1% female). The intracranial stenotic lesions were located in the anterior circulation in 135 (58.2%) cases. Recurrent stroke was the qualifying event in 165 (71.1%) while recurrent TIA was identified in 67 (28.9%) cases. The median (IQR) time from the qualifying event to stenting was 5 (2–20.75) days. Strokes were reported in 13 (5.6%) patients within 72 hours of the procedure; 9 (3.9%) ischemic and 4 (1.7%) hemorrhagic, and mortality in 2 (0.9%) cases. Among 189 patients with median follow-up time 6 (3–14.5) months, 12 (6.3%) had TIA and 7 (3.7%) had strokes. Three patients (1.6%) died from causes not related to stroke.ConclusionOur study has shown that BMS may be a safe and effective treatment for medically refractory symptomatic ICAD. Additional prospective randomized clinical trials are warranted.

Stenting and Angioplasty in Neurothrombectomy: Matched Analysis of Rescue Intracranial Stenting Versus Failed Thrombectomy

“…10,12,22,33 Furthermore, it has been described that rates of sICH does not seem to increase after acute stenting of the cervical intracranial internal carotid artery in patients with LVOS and tandem occlusions nor after intracranial stenting in those with ICAD who were treated within 24 hours of the qualifying event. 34–36 Interestingly, subgroup analysis showed lower odds of sICH in patients who received IV tPA (unadjusted OR, 0.84 [95% CI, 0.73–0.97]; P =0.03). While no significance was achieved, our results align with a previous study showing numerically lower rates of sICH in patients who received glycoprotein IIb/IIIa inhibitors and underwent RS after IV tPA administration than not (4.0% versus 5.1%, P =0.999).…”

Rescue Endovascular Treatment for Emergent Large Vessel Occlusion With Underlying Intracranial Atherosclerosis: Current State and Future Directions

“…The advantage of balloon-mounted stents is the added radial force as compared in Neuro-Form atlas (Stryker Neurovascular) and the pre-balloon angioplasty associated with deployment; however, due to their stiffness, navigating such stents could be challenging, particularly in tortuous anatomy. Mohammaden et al recently evaluated the use of balloon-mounted stent in the treatment of symptomatic ICAS ( 46 ). Among 232 patients with symptomatic ICAS patients who failed medical management and were treated with balloon-mounted stents, 5.6% had strokes within 72 h, 3.9% were ischemic, and 1.7% were hemorrhagic.…”

Functional evaluation of intracranial atherosclerotic stenosis by pressure ratio measurements

“…However, even with aggressive medical treatment, symptomatic ICAS patients with severe stenosis are still at high risk of stroke. Thus, intervention is an important treatment alternative for these patients [ [5] , [6] , [7] ]. Some clinical studies have demonstrated the short-term efficacy of endovascular stenting in severe symptomatic ICAS patients, although its effecicacy is still controversial [ [8] , [9] , [10] ].…”