Comparison of Drug-eluting Coronary Stents, Bare Coronary Stents and Self-expanding Stents in Angioplasty of Middle Cerebral Artery Stenoses

Lee, Jong-Hyeog; Jo, Sung-Min; Jo, Kyung-Wook; Kim, Moonkyu; Lee, Sang-Youl; You, Seung-Hoon

doi:10.7461/jcen.2013.15.2.85

Cited by 15 publications

(8 citation statements)

References 36 publications

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“…To our knowledge, this is the first randomized, multicenter, prospective, drug-eluting stent trial for symptomatic intracranial stenosis and vertebral artery stenosis. Although it differed in its design and the type of stent used, this study showed similar results to some previous clinical trials (2,3,(5)(6)(7)(8)(9). In the current trial, a lower rate of ISR was shown with DES than with BMS in symptomatic intracranial arterial stenosis and vertebral artery stenosis.…”

Section: Discussionsupporting

confidence: 86%

Effect of a Drug-Eluting Stent vs. Bare Metal Stent for the Treatment of Symptomatic Intracranial and Vertebral Artery Stenosis

Gao

et al. 2022

Front. Neurol.

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BackgroundFor patients with symptomatic intracranial and vertebral artery stenosis who receive endovascular treatment, in-stent restenosis (ISR) is associated with the recurrence of ischemic stroke. This study evaluated a drug-eluting stent (DES) vs. bare metal stent (BMS) for the treatment of symptomatic intracranial and vertebral artery stenosis.MethodsThe trial was a multicenter, 1:1 randomized, prospective feasibility clinical trial with 10 participating centers in China from March 2014 to October 2015. Eligible patients had symptomatic intracranial and vertebral artery stenosis (70%−99%) and had medical drug treatment failure. The primary endpoint was the rate of in-stent restenosis at 180 days of randomization. The secondary endpoint was a composite of the following two outcomes: (1) ischemic stroke or transient cerebral ischemia (TIA) in the same territory as the presenting event (distal to the target lesion) between 30 days and 1 year after randomization and (2) successful stent implantation. The safety outcome was the presence of stroke in any territory and death within 30 days of randomization or adverse events. Group t-tests or Wilcoxon rank-sum tests were used for the intergroup comparison of quantitative data according to the data distribution. The chi-square test or exact probability method was used for the classification data. The Wilcoxon rank-sum test or CMH test was used for the categorical data.ResultsWe enrolled 188 patients at 10 medical centers in China (92 assigned to the DES group and 96 to the BMS group). The mean age of the 188 study participants was 61.6 years (range, 38–75 years); 152 participants (80.9%) were male. There were 28 patients (43.8%) with an ISR at 180 days in the BMS group and 10 patients (14.5%) in the DES group [risk difference, 29.3% (95% CI, 14.5%−44.0%); P = 0.001]. The percent of patients with ischemic stroke or TIA in the same territory between 30 days and 1 year was 5.2% (5/96) in the BMS group and 2.2% (2/92) in the DES group [risk difference, 3.0%; (95% CI, −2.3% to 8.2%); P = 0.354]. The percent of patients with successful stent implantation was 99.0% (95/96) in the BMS group and 97.8% (90/92) in the DES group [risk difference, 1.1%; (95% CI, −1.7% to 3.9%); P = 0.584]. In total, five patients (5.2%) in the BMS group and three patients (3.3%) in the DES group [risk difference, 1.9%; (95% CI, −2.3% to 6.1%); P = 0.721] had stroke in any territory and death within the 30-day follow-up. Total adverse events occurred 167 times in 72 patients (75.0%) in the BMS group compared with 114 times in 59 patients (64.1%) in the DES group [risk difference, 10.9%; (95% CI, −0.1% to 21.7%); P = 0.115].ConclusionsAmong patients with symptomatic intracranial arterial stenosis and vertebral artery stenosis, the use of a drug-eluting stent compared with a bare metal stent resulted in a decreased risk of ISR, similar successful stent implantation, and similar adverse events. These findings support the use of a drug-eluting stent for patients with symptomatic intracranial arterial stenosis and vertebral artery stenosis.Clinical Trial Registrationhttp://www.chictr.org.cn/showproj.aspx?proj=148272, identifier: ChiCTR2200055925.

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Section: Discussionsupporting

confidence: 86%

Effect of a Drug-Eluting Stent vs. Bare Metal Stent for the Treatment of Symptomatic Intracranial and Vertebral Artery Stenosis

Gao

et al. 2022

Front. Neurol.

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“…However, the investigators reported that there was no restenosis in the cases with drug-eluting stent (Lee et al 2013). The restenosis is associated with the angle of the lesion.…”

Section: Discussionmentioning

confidence: 99%

“…The SSYLVIA study reported the restenosis rate of ≥50 % at 6 months was 32.4 % (The SSYLVIA Study Investigators 2004 ). However, the investigators reported that there was no restenosis in the cases with drug-eluting stent (Lee et al 2013 ). The restenosis is associated with the angle of the lesion.…”

Section: Discussionmentioning

confidence: 99%

The experiences of balloon-expandable stent in symptomatic stenosis of middle cerebral artery

Tang

Liu

et al. 2016

SpringerPlus

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BackgroundStent placement for middle cerebral artery (MCA) stenosis remains a technical and clinical challenge. Our purpose was to assess the safety and feasibility of balloon-expandable stent (BES) for patients with symptomatic M1 stenosis of MCA, and to introduce our experience during the procedure.MethodsIn the study, we analyzed retrospectively 37 patients with M1 stenosis of the MCA ranged from 70 to 90 % in diameter reduction and refractory to medical therapy between January 2012 and January 2015. All the patients underwent angioplasty and stenting with BES, and followed up continuously.ResultsThirty-five out of 37 patients were successfully followed up and available until now. The technical successful rate was 100 % for all the lesions. The complication rate was 0 during the procedure. Stroke occurred to one patient at 4th day after the procedure. There were two patients experiencing slight stroke after 8 months. Two patients were found re-stenosis >50 % without any symptom. The stroke rate of 12 months was 8.57 % (3/35).ConclusionsAngioplasty associated with BES appears to be safe and feasible for the patients with symptomatic M1 stenosis of MCA. Our experiences about the BES may be valuable for decreasing the complication. However, further study is needed.

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“…Lee et al compared DESs, bare-metal coronary stents (BMSs), and self-expanding stents (SESs) in angioplasty of MCA atherosclerotic stenosis. They reported a reduction of ISR with DESs compared with BMSs and SESs [19]. To combat the consequences of neointimal proliferation, DESs and balloon angioplasty alone have been used in a few cases to treat ISR [9].…”

Section: Discussionmentioning

confidence: 99%

Tandem Short-length Multi-stent Construct for Emergent Revascularization of Occlusive Long-segment Left Middle Cerebral Artery In-stent Stenosis

Karsonovich

Bolt²,

Gordhan

2020

Cureus

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Endovascular stenting and balloon angioplasty is a feasible although controversial option for intracranial atherosclerotic stenosis refractory to maximize medical management. High rates of symptomatic in-stent restenosis (ISR) have been identified with Wingspan stent (Stryker, Fremont, CA, USA) placement. Revascularization of ISR by way of re-stenting is often attempted, albeit with high risk and low durability. In lesions with long-segment non-focal critical or emergent occluded stenosis, re-stenting with a single balloon mounted stent is not possible due to deliverability of a lengthy device through a tortuous carotid siphon. Tandem drug-eluting stent placement within the middle cerebral artery to address acute, occlusive ISR using a Wingspan stent, with additional stent reconstruction, has not been previously described.

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Comparison of Drug-eluting Coronary Stents, Bare Coronary Stents and Self-expanding Stents in Angioplasty of Middle Cerebral Artery Stenoses

Cited by 15 publications

References 36 publications

Effect of a Drug-Eluting Stent vs. Bare Metal Stent for the Treatment of Symptomatic Intracranial and Vertebral Artery Stenosis

Effect of a Drug-Eluting Stent vs. Bare Metal Stent for the Treatment of Symptomatic Intracranial and Vertebral Artery Stenosis

The experiences of balloon-expandable stent in symptomatic stenosis of middle cerebral artery

Tandem Short-length Multi-stent Construct for Emergent Revascularization of Occlusive Long-segment Left Middle Cerebral Artery In-stent Stenosis

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