Journal of Stroke and Cerebrovascular Diseases

2021

DOI: 10.1016/j.jstrokecerebrovasdis.2020.105556

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Current Advances in Endovascular Treatment of Intracranial Atherosclerotic Disease and Future Prospective

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Thanh N. Nguyen

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Santiago Ortega‐Gutiérrez

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et al.

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Cited by 8 publications

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“…14 In Asia, patients with LAA stroke have better effects after EVT than patients with CE. 15,16 The LAA group in this study had better collateral circulation than the CE group, and its NIHSS score was lower, and the results were different from the anterior circulation. The reason may be that endovascular treatment of BAO is more laborious, has more complications, and has a higher rate of ineffective recanalization.…”

Section: Discussionmentioning

confidence: 62%

A Study on the Efficacy of Thrombectomy in Patients with Atherosclerotic and Cardioembolic Basilar Artery Occlusion

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et al. 2023

J Neurol Surg B Skull Base

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Background Studies on basilar artery occlusion are relatively few compared with those of anterior circulation stroke. The present study was to compare the efficacy of endovascular therapy (EVT) in patients with basilar artery occlusion classified as large artery atherosclerosis (LAA) and cardioembolism (CE), and analyze the independent risk factors affecting the prognosis of EVT. Methods 123 people were assigned to the LAA group and the CE group(97 to the LAA and 26 to the CE). The primary outcome was a modified Rankin scale (mRS) score of 2 or lower at 90 days, The primary safety outcome was mortality at 90 days. Secondary safety endpoints included the rates of symptomatic intracranial haemorrhage and reinfarction. Multivariate logistic regression was performed to determine independent predictors of EVT prognosis. Results In the analysis, the patients with LAA stroke were had better collateral circulation (ASITN/SIR score of 2–4; 61.9% versus 19.2%, p=0.000), and higher angioplasty rate (32.0% versus 3.8%, p=0.002) compared with CE. The proportion of patients with 90-day mRS score of 0–2 points, and the 90-day mortality rate were not statistically significant. Multivariate logistic regression analysis indicated that Age, SIR, WBC, GLU, and mTICI were independent risk factors for the poor prognosis of EVT in the LAA group. Conclusions Although there were differences in clinical characteristics and imaging features between LAA and CE in posterior circulation, there was no evidence of a significant difference in prognosis after EVT. However, their independent prognostic factors for poor prognosis had differences.

“…14 In Asia, patients with LAA stroke have better effects after EVT than patients with CE. 15,16 The LAA group in this study had better collateral circulation than the CE group, and its NIHSS score was lower, and the results were different from the anterior circulation. The reason may be that endovascular treatment of BAO is more laborious, has more complications, and has a higher rate of ineffective recanalization.…”

Section: Discussionmentioning

confidence: 62%

A Study on the Efficacy of Thrombectomy in Patients with Atherosclerotic and Cardioembolic Basilar Artery Occlusion

¹

,

²

,

³

et al. 2023

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Background Studies on basilar artery occlusion are relatively few compared with those of anterior circulation stroke. The present study was to compare the efficacy of endovascular therapy (EVT) in patients with basilar artery occlusion classified as large artery atherosclerosis (LAA) and cardioembolism (CE), and analyze the independent risk factors affecting the prognosis of EVT. Methods 123 people were assigned to the LAA group and the CE group(97 to the LAA and 26 to the CE). The primary outcome was a modified Rankin scale (mRS) score of 2 or lower at 90 days, The primary safety outcome was mortality at 90 days. Secondary safety endpoints included the rates of symptomatic intracranial haemorrhage and reinfarction. Multivariate logistic regression was performed to determine independent predictors of EVT prognosis. Results In the analysis, the patients with LAA stroke were had better collateral circulation (ASITN/SIR score of 2–4; 61.9% versus 19.2%, p=0.000), and higher angioplasty rate (32.0% versus 3.8%, p=0.002) compared with CE. The proportion of patients with 90-day mRS score of 0–2 points, and the 90-day mortality rate were not statistically significant. Multivariate logistic regression analysis indicated that Age, SIR, WBC, GLU, and mTICI were independent risk factors for the poor prognosis of EVT in the LAA group. Conclusions Although there were differences in clinical characteristics and imaging features between LAA and CE in posterior circulation, there was no evidence of a significant difference in prognosis after EVT. However, their independent prognostic factors for poor prognosis had differences.

“…Indeed, symptomatic intracranial arterial stenoses are usually treated with PTA or stenting only after failure of medical management. 13 However, in this case we thought that the atherosclerotic stenosis could be the cause of pulsatile tinnitus, so intracranial PTA and stenting were proposed to the patient in order to both improve the tinnitus and prevent further ischaemic events. Tinnitus has immediately disappeared after the procedure, thus confirming the relationship between the stenosis and the disabling bruit.…”

Section: Discussionmentioning

confidence: 93%

Pulsatile tinnitus due to stenosis of the supraclinoid segment of the internal carotid artery: Management with a low-profile self-expanding stent

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et al. 2022

Interv Neuroradiol

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Atherosclerotic stenosis of the internal carotid artery is a rare cause of pulsatile tinnitus. Stenosis responsible for tinnitus is usually located in the petrous segment of the vessel or, even more uncommonly, in the extracranial segment. However, to the best of our knowledge, a stenosis of the intradural supraclinoid segment of the internal carotid had never been reported as a source of pulsatile tinnitus. We describe the case of a man with a history of previous ischaemic stroke and invalidating pulsatile tinnitus, caused by a high grade, diaphragm-like shaped, stenosis of the supraclinoid internal carotid artery. The stenosis was treated with angioplasty and stenting with a low-profile self-expanding high radial force stent (Acclino flex HRF, Acandis). Tinnitus disappeared immediately after the procedure. At the two-year follow-up no recurrence of the tinnitus and the stenosis occurred. Intradural internal carotid artery stenosis should be considered as a very rare cause of pulsatile tinnitus.

“…Intracranial angioplasty and stenting are beneficial for selected patient cohorts and have been used widely in many experienced centers (9,31). After stent placement, imaging surveillance is necessary to monitor for in-stent restenosis (12).…”

Section: Discussionmentioning

confidence: 99%

The Use of Pointwise Encoding Time Reduction With Radial Acquisition MRA to Assess Middle Cerebral Artery Stenosis Pre- and Post-stent Angioplasty: Comparison With 3D Time-of-Flight MRA and DSA

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et al. 2021

Front. Cardiovasc. Med.

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Background and Purpose: 3D pointwise encoding time reduction magnetic resonance angiography (PETRA-MRA) is a promising non-contrast magnetic resonance angiography (MRA) technique for intracranial stenosis assessment but it has not been adequately validated against digital subtraction angiography (DSA) relative to 3D-time-of-flight (3D-TOF) MRA. The aim of this study was to compare PETRA-MRA and 3D-TOF-MRA using DSA as the reference standard for intracranial stenosis assessment before and after angioplasty and stenting in patients with middle cerebral artery (MCA) stenosis.Materials and Methods: Sixty-two patients with MCA stenosis (age 53 ± 12 years, 43 males) underwent MRA and DSA within a week for pre-intervention evaluation and 32 of them had intracranial angioplasty and stenting performed. The MRAs' image quality, flow visualization within the stents, and susceptibility artifact were graded on a 1–4 scale (1 = poor, 4 = excellent) independently by three radiologists. The degree of stenosis was measured by two radiologists independently on DSA and MRAs.Results: There was an excellent inter-observer agreement for stenosis assessment on PETRA-MRA, 3D-TOF-MRA, and DSA (ICCs > 0.90). For pre-intervention evaluation, PETRA-MRA had better image quality than 3D-TOF-MRA (3.87 ± 0.34 vs. 3.38 ± 0.65, P < 0.001), and PETRA-MRA had better agreement with DSA for stenosis measurements compared to 3D-TOF-MRA (r = 0.96 vs. r = 0.85). For post-intervention evaluation, PETRA-MRA had better image quality than 3D-TOF-MRA for in-stent flow visualization and susceptibility artifacts (3.34 ± 0.60 vs. 1.50 ± 0.76, P < 0.001; 3.31 ± 0.64 vs. 1.41 ± 0.61, P < 0.001, respectively), and better agreement with DSA for stenosis measurements than 3D-TOF-MRA (r = 0.90 vs. r = 0.26). 3D-TOF-MRA significantly overestimated the stenosis post-stenting compared to DSA (84.9 ± 19.7 vs. 39.3 ± 13.6%, p < 0.001) while PETRA-MRA didn't (40.6 ± 13.7 vs. 39.3 ± 13.6%, p = 0.18).Conclusions: PETRA-MRA is accurate and reproducible for quantifying MCA stenosis both pre- and post-stenting compared with DSA and performs better than 3D-TOF-MRA.

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