Abstract 1122‐000095: Revisiting the Role of Angioplasty and Stenting for Symptomatic Intracranial Stenosis ‐ A Case Series

Abstract

Introduction : Early and long‐term results of the SAMMPRIS trial showed superiority of aggressive medical management over stenting in patients with symptomatic intracranial stenosis, in part due to the high risk of periprocedural complications. However, even with maximal medical management, the risk of recurrent TIA or stroke in patients with high‐grade stenosis often remains elevated. Methods : A review of our stroke database was conducted, identifying three relevant cases. Results : CASE 1: A 69 year‐old man with multiple vascular risk factors and atrial fibrillation on apixaban presented with several months of multiple stereotyped episodes of limb‐shaking TIAs affecting the left leg, often leading to falls. CT angiogram revealed 70–80% stenosis of A2 segment of right ACA. Symptoms completely resolved after stenting with Neuroform Atlas stent. Repeat angiogram at 6 months showed excellent vessel caliber. CASE 2: A 78 year‐old man with hypertension, DM, CAD, and known left ICA occlusion presented with recurrent episodes of aphasia and right arm weakness while on maximal medical therapy. CT angiogram showed severe right supraclinoid ICA stenosis which was corrected with Resolute Onyx DES stent with improvement of symptoms. CASE 3: A 77 year‐old with hypertension, DM, CAD and aortic dissection on dual antiplatelet therapy and high‐intensity statin was admitted with stereotyped, blood pressure‐dependent episodes of aphasia and right face/arm weakness secondary to high‐grade stenosis of both M2 divisions of the left MCA. Successful angioplasty and Y‐stenting with Neuroform EZ and Wingspan stents led to complete resolution of symptoms. Conclusions : At high‐volume centers and with newer interventional devices and techniques, intracranial angioplasty and stenting should be considered as a valuable therapeutic option in patients with symptomatic intracranial stenosis refractory to maximal medical therapy.