Applications of stenting for intracranial atherosclerosis

Abstract

<jats:p>Intracranial atherosclerosis presents a therapeutic challenge to medical and surgical physicians alike. Despite maximal medical therapy, the stroke rate from this disease is still high, especially when arterial stenosis is severe and patients are symptomatic. Open surgical therapy has yet to be shown to be a more efficacious treatment than medical therapy alone, largely due to the relatively high rates of perioperative complications. Angioplasty has a similar fate, with the risk of periprocedural complications outweighing the overall benefit of treatment. With the advent of stents for use in intracranial vasculature, new hope has arisen for the treatment of intracranial atherosclerosis. The NEUROLINK system, the drug-eluting stents Taxus and Cypher, the flexible Wingspan stent, the Apollo stent, and the Pharos stent have all been used in various prospective and retrospective clinical studies with varying technical and clinical results. The authors' objective is to review and loosely compare the data presented for each of these stenting systems. While the Wingspan stent appears to have somewhat of an advantage with regard to technical success in comparison with the other stenting systems, the clinical follow-up time of its studies is too short to properly compare its complication rates with those of other stents. Before we continue to move forward with stenting for intracranial stenosis, a randomized prospective trial is ultimately needed to directly compare intracranial stenting to medical therapy.</jats:p>

Alterations in Treatment Preferences for Intracranial Atherosclerotic Disease following SAMMPRIS

“…The three time periods were pre-WASID, post-WASID, and post-SAMMPRIS. In the current (post-SAMMPRIS) era of ICAD management, the role of endovascular treatment remains unknown [4]. A survey of over 200 attendees of the ICAD symposium at the 2012 International Stroke Conference by Zaidat et al [5] showed, in congruence with the present study, that the results from SAMMPRIS significantly dampened the enthusiasm of neurologists and neurointerventionists to prescribe stenting for the treatment of symptomatic ICAD.…”

Modern management of paraclinoid aneurysms: Rise of flow diversion and fall of microsurgery

“…As our understanding of aneurysm biology and treatment outcomes continues to evolve, novel medical therapies or technologies may arise which will reduce the role of microsurgery in the management of paraclinoid aneurysms to the point of extinction [8][9][10][11][12][13][14]. Until such time, it remains crucial for vascular neurosurgeons to maintain proficiency in the microsurgical treatment of paraclinoid aneurysms, for which the use of certain maneuvers, such as anterior clinoidectomy and extracranial-intracranial bypass, is becoming increasingly uncommon.…”

Ophthalmologic course of bilateral abducens nerve palsies after the treatment of idiopathic intracranial hypertension with venous sinus stenting

“…At our institution, a venous pressure gradient of at least 10 mmHg across the stenotic segment is necessary to be considered for VSS. In contrast to stents deployed in intracranial arteries, in-stent stenosis or occlusion rarely occurs after stenting of major dural venous sinuses, although stent-adjacent stenosis tends to develop after VSS [4][5][6]. Additionally, VSS may be more cost-effective than CSF diversion, due to a significantly lower reoperation rate [7].…”