A retrospective study of individualized endovascular treatment for symptomatic intracranial atherosclerotic stenosis in patients with ischemic stroke/transient ischemic attack

Abstract

BackgroundEndovascular treatment (EVT) is one of the effective treatment procedure for the symptomatic intracranial atherosclerotic stenosis (sICAS).Aim and methodsWe evaluated the efficacy and safety of individualized endovascular treatment for sICAS patients. Clinical and imaging follow-ups were carried out to collect the data of 29 sICAS patients after 6 months of individualized endovascular treatment. Different treatment strategies are selected based on arterial access and lesion morphology of patients. If standard surgical path, narrow artery straight, stenosis length ≤10 mm, then the appropriate specifications of balloon-mounted stent (BMS) treatment. the surgical path is tortuous, the narrow artery is curved, the angle is apparent, the diameter of the near and far ends is significantly different, or the length of the stenosis is >10 mm, self-expanding stent (SES) with appropriate specifications is selected for treatment. If the narrowed artery is hyper flexed and the surgeon deems stenting inappropriate, balloon dilation angioplasty (BDA) treatment is chosen.Results and conclusion31 lesions of 29 sICAS patients received endovascular treatment. The median age was 61 years (IQR 54–69 years). The median preoperative stenosis was 90% (IQR 80–95%), and the mean stenosis length was (8.10 ± 3.27) mm. The most commonly used surgical procedure was Balloon-Mounted Stent (BMS) in 19 cases (65.52%), Self-expanding Stent (SES) in seven cases (24.14%), Balloon Dilation Angioplasty (BDA) in three cases (10.34%). (11.86 + 1.46 mm) was greater than that in the BMS group (6.14 + 1.59 mm) (P < 0.001). The median stenosis was 90% (IQR 80–92.5%) in the BMS group, lower than 99% (IQR 95–100%) in the SES group (P < 0.001). The median post-operative residual stenosis was 20% (IQR 15–25%), significantly improved compared with preoperative (P < 0.001). The success rate of the surgical technique was 93.10% (27/29). One patient (3.45%) had IS recurrence within 48 h after surgery, and the restenosis rate within 6 months after surgery was 6.90% (2/29). No patient died or had recurrent IS. Our data demonstrated that individualized endovascular treatment method could be potentially significant and safe for sICAS patients. This study will provide an important reference for the endovascular treatment of sICAD.

Drug-coated balloon angioplasty for the treatment of intracranial arterial stenosis in a young stroke patient: A case report

“…In such cases, drug-coated balloon angioplasty emerges as a potentially appropriate therapeutic avenue[ 1 , 2 ]. Conversely, for elderly patients grappling with severe atherosclerotic intracranial arterial narrowing and experiencing recurrent events despite conventional medical management, stent placement may warrant consideration[ 3 ]. Considering the patient's youthfulness, minimal blood pressure elevation, and absence of atherosclerosis risk factors, the occurrence of ischemic stroke events related to right middle cerebral artery stenosis despite anti-platelet and intensive lipid-lowering therapy is noteworthy.…”

Percutaneous angioplasty and/or stenting versus aggressive medical therapy in patients with symptomatic intracranial atherosclerotic stenosis: a 1-year follow-up study

“…At day 30, the incidence of the primary endpoint (any stroke or death) was 14.7% vs. 5.8% (P = 0.0016) and 24.1% vs. 9.4% (P = 0.050) in the stenting and medical groups, respectively. This difference may be attributed to the perioperative risk of surgery (Turan et al, 2022), the timing of stenting (Derdeyn et al, 2014;Zaidat et al, 2015;Gao et al, 2022) and difference in stent selection, such as BMS, SES, and simple balloon dilation angioplasty (BDA) (Mao et al, 2022;Ueda et al, 2022) as well as the plaque detachment or reperfusion injury (Yaghi et al, 2019). The CASSISS (Gao et al, 2022) trial demonstrated that minimizing perioperative complications did not result in a significant difference in the risk of stroke within 30 days or beyond 30 days to 1 year (8.0% vs. 7.2%, P = 0.820).…”

“…When endovascular treatment was performed over 3 weeks, the incidence of short-term death or stroke was 4.3% and 2%, respectively (Miao et al, 2015a;Wang et al, 2020). The CASSISS trial (median time, 35 days) (Gao et al, 2022), WEAVE trial (median time, 22 days) (Alexander et al, 2019) and a retrospective study trial (median time, 21 days) (Mao et al, 2022) had significantly longer interval from onset to endovascular treatment than the SAMMPRIS trial (median time, 7 days) (Derdeyn et al, 2014) and VISSIT trial (median time, 9 days) (Zaidat et al, 2015), thus avoiding the highest risk period of stroke recurrence. This approach also reduced the incidence of perioperative complications after stenting.…”

“…Another study have shown that the 30-day stroke or mortality of stenting is significantly higher than that of medical therapy, suggesting that aggressive medical therapy is superior to PTAS in patients with sICAS (Derdeyn et al, 2014). However, a number of subsequent prospective and retrospective studies have reported the benefits of endovascular therapy (Yu et al, 2012;Miao et al, 2015a,b;Gao et al, 2016;Maier et al, 2018), and individualized endovascular therapy may be effective and safe in patients with sICAS (Ma et al, 2018;Mao et al, 2022). Therefore, the optimal treatment of patients with sICAS remains elusive.…”