Stenting for symptomatic intracranial arterial stenosis in China: 1-year outcome of a multicentre registry study

Abstract

Background and purposeA multicentre prospective registry study of individually tailored stenting for a patient with symptomatic intracranial atherosclerotic stenosis (ICAS) combined with poor collaterals in China showed that the short-term safety and efficacy of stenting was acceptable. However, it remained uncertain whether the low event rate could be of a long term. We reported the 1-year outcome of this registry study to evaluate the long-term efficacy of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals.MethodsPatients with symptomatic ICAS caused by 70%–99% stenosis located at the intracranial internal carotid, middle cerebral, intracranial vertebral or basilar arteries combined with poor collaterals were enrolled. Balloon-mounted stent or balloon plus self-expanding stent were selected based on the ease of vascular access and lesion morphology determined by the operators. The primary outcome was the rate of 30-day stroke, transient ischaemic attack and death, and 12-month ischaemic stroke within the same vascular territory, haemorrhagic stroke and vascular death after stenting.ResultsFrom September 2013 to January 2015, 300 patients (ages 58.3±9.78 years) were recruited. Among them, 159 patients were treated with balloon-mounted stent and 141 with balloon plus self-expanding stent. During the 1-year follow-up, 25 patients had a primary end point event. The probability of primary outcome at 1 year was 8.1% (95% CI 5.3% to 11.7%). In 76 patients with digital subtraction angiography follow-up, 27.6% (21/76) had re-stenosis ≥50% and 18.4% (14/76) had re-stenosis ≥70%. No baseline characteristic was associated with the primary outcome.ConclusionThe event rate remains low over 1 year of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals. Further randomised trial of comparing individually tailored stenting with best medical therapy is needed.Trial registration numberNCT01968122; Results.

Balloon-mounted stenting for ICAS in a multicenter registry study in China: a comparison with the WEAVE/WOVEN trial

“…Details of the registry have been published elsewhere. [19][20][21] Approval by each site's institutional review board or ethics committee was obtained. Written informed consent was obtained from the patients or their legally authorized representatives.…”

Is the future of symptomatic intracranial atherosclerotic stenosis management promising?

“…In a recent Chinese sICAS Registry (NCT01968122),22 all participants were enrolled for hypoperfusion aetiology with poor collaterals within 90 days after onset, and received individualised endovascular treatment. Patients had 4.3% and 8.1% of stroke recurrence at 30 days and 1 year, respectively,22 23 which is quite lower than in the SAMMPRIS Trial. Despite ethnic differences between various trials, we believe that the results of the Chinese Trial were better mainly due to the highly selective patient enrolment.…”

Update in the treatment of intracranial atherosclerotic disease

“…These both demonstrated approximately 6% periprocedural complication rate and represented the initial clinical experience with the stent in the USA. Subsequent large clinical series were reported by multiple centres in both single-centre registries and multicentre trials 29–36…”

“…Following SAMMPRIS, there have been several single-centre and multicentre trials and registries that have demonstrated much safer periprocedural results with the Wingspan stent, provided that the time to treatment was delayed 2–3 weeks following the last stroke 29–36. In a multicentre trial comparing a balloon-expandable stent with the Wingspan self-expanding stent in over 300 patients, Ma et al 34. demonstrated a 4% periprocedural complication rate, and a total 1-year follow-up stroke, TIA, bleed and death rate of 7.9% in the Wingspan-treated group.…”