Journal of Clinical Neuroscience

2019

DOI: 10.1016/j.jocn.2018.10.118

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Efficacy and safety of drug-eluting stent for the intracranial atherosclerotic disease: A systematic review and meta-analysis

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-Month Angiogram (9 Patients)2

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Long-term Efficacy and In-stent Restenosis1

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Cited by 34 publications

(32 citation statements)

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“…The reported overall complications rate of endovascular treatment for intracranial stenosis is around 10%, and the unfavorable clinical outcome rate is around 5% [24][25][26]. The reported complications rate of endovascular treatment for UIAs is 4.9% [27] and unfavorable outcome is around 4.8% [28].…”

Section: Discussionmentioning

confidence: 99%

Safety of Endovascular Treatment for Concomitant Unruptured Intracranial Aneurysms and Cerebral Vascular Stenosis

Jin¹,

Jing²,

et al. 2020

Preprint

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Abstract Background To evaluate the safety of endovascular therapy for concomitant unruptured intracranial aneurysms (UIAs) and cerebral vascular stenosis. Methods Patients between January to August 2019 were retrospectively reviewed at our institution. Concomitant UIA and cerebral vascular stenosis patients underwent endovascular treatment were included. The demographics and clinical information were collected. Patients were divided into 4 groups according to lesions that was treated (aneurysm, stenosis, both lesions in a single session or in separated sessions). Patients were divided into another 2 groups based on locations of aneurysm and stenosis (ipsilateral and non-ipsilateral). The demographics and clinical data were compared among groups. Results A total of 105 (4.9%) cases have concomitant UIA and cerebral vascular stenosis. Eighty-one patients underwent endovascular treatment for the stenosis(n=18), aneurysm(n=41) or both lesions (one session=10; separated sessions n=12). Seven (8.6%) patients experienced procedural related complications, including 1 (1.2%) hemorrhagic and 6 (7.4%) ischemic types. In terms of procedures, 4 (6.3%) complications is related with UIA embolization, 2(5.0%) related with intracranial stenosis angioplasty. Complication rate of patients underwent intracranial angioplasty and aneurysm embolization simultaneously is much higher (20%) than that of the other groups (5.6%-8.3%). Patients with ipsilateral lesions also had higher complication rate (11.1%) than non-ipsilateral patients (6.7%). Follow-up (74 patients, mean=6.5months) result showed good clinical outcome in 70 (94.6%) patients. Conclusions Simultaneous treatment for concomitant UIA and extracranial stenosis may not pose additional risks. Ipsilateral lesions and single session procedure for intracranial stenosis and UIA are potential risk factors for periprocedural complications.

“…The reported overall complications rate of endovascular treatment for intracranial stenosis is around 10%, and the unfavorable clinical outcome rate is around 5% [24][25][26]. The reported complications rate of endovascular treatment for UIAs is 4.9% [27] and unfavorable outcome is around 4.8% [28].…”

Section: Discussionmentioning

confidence: 99%

Safety of Endovascular Treatment for Concomitant Unruptured Intracranial Aneurysms and Cerebral Vascular Stenosis

Jin¹,

Jing²,

et al. 2020

Preprint

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Abstract Background To evaluate the safety of endovascular therapy for concomitant unruptured intracranial aneurysms (UIAs) and cerebral vascular stenosis. Methods Patients between January to August 2019 were retrospectively reviewed at our institution. Concomitant UIA and cerebral vascular stenosis patients underwent endovascular treatment were included. The demographics and clinical information were collected. Patients were divided into 4 groups according to lesions that was treated (aneurysm, stenosis, both lesions in a single session or in separated sessions). Patients were divided into another 2 groups based on locations of aneurysm and stenosis (ipsilateral and non-ipsilateral). The demographics and clinical data were compared among groups. Results A total of 105 (4.9%) cases have concomitant UIA and cerebral vascular stenosis. Eighty-one patients underwent endovascular treatment for the stenosis(n=18), aneurysm(n=41) or both lesions (one session=10; separated sessions n=12). Seven (8.6%) patients experienced procedural related complications, including 1 (1.2%) hemorrhagic and 6 (7.4%) ischemic types. In terms of procedures, 4 (6.3%) complications is related with UIA embolization, 2(5.0%) related with intracranial stenosis angioplasty. Complication rate of patients underwent intracranial angioplasty and aneurysm embolization simultaneously is much higher (20%) than that of the other groups (5.6%-8.3%). Patients with ipsilateral lesions also had higher complication rate (11.1%) than non-ipsilateral patients (6.7%). Follow-up (74 patients, mean=6.5months) result showed good clinical outcome in 70 (94.6%) patients. Conclusions Simultaneous treatment for concomitant UIA and extracranial stenosis may not pose additional risks. Ipsilateral lesions and single session procedure for intracranial stenosis and UIA are potential risk factors for periprocedural complications.

“…In our series, bare metal stents were used, but in the future, it may be difficult to obtain bare metal stents due to advances in drug-eluting stents (DESs) in the field of cardiology. According to a systematic review reported by Ye et al, 11) DES insertion to the site of intracranial stenosis is relatively safe, but evidence has not been established; it should be established early. Although a Wingspan was used in the acute phase only in one patient in this study, on a post-marketing survey on Wingspan (JAPAN PMS), 305 patients were registered between June 2014 and July between the site of occlusion and prognosis, but the site of occlusion was located at an area proximal to the middle segment of the basilar artery in all patients.…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Initial Results of Percutaneous Transluminal Angioplasty/Stenting for Vertebrobasilar Occlusion due to Atherothrombotic Disease during Acute Phase

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et al. 2021

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The efficacy and safety of acute percutaneous transluminal angioplasty or stenting (PTA/PTAS) for vertebrobasilar artery occlusion with atherothrombotic brain infarction (ATBI) have not been confirmed despite the resistance to medical therapy alone. There are few reports about this disease and its treatment. Therefore, the treatment outcomes at our hospital were summarized to evaluate the efficacy and safety. Methods: This was a retrospective study of acute PTA/PTAS for vertebrobasilar artery occlusion due to atherosclerotic change in 19 consecutive patients with a modified Rankin Scale (mRS) score of 0-2 before stroke between March 2010 and December 2018. The factors related to prognosis were investigated. Outcomes were assessed at 90 days of follow-up. Results: Of 19 patients with acute vertebrobasilar artery occlusion treated by PTA/PTAS, 8 had good outcomes (mRS 0-2) and 11 had poor outcomes (mRS 3-6). There were no differences in the clinical or patient background except for the National Institutes of Health Stroke Scale (NIHSS) score between groups. The good outcome group had a lower NIHSS score than the poor outcome group (median: 9.5 vs 35, p <0.001). The Thrombolysis in Cerebral Ischemia (TICI) 2b-3 group had a slightly more favorable outcome than the TICI0-2a group (p = 0.10). There were no differences in outcome between PTA and PTAS groups (p = 0.65). Conclusion: Reperfusion of the posterior circulation by PTA/PTAS may be necessary for a good outcome. Although acute stenting must be performed under careful observation, a stent can be placed when recurrence in the early phase is estimated with high probability. Keywords▶ vertebrobasilar occlusion, atherosclerotic change, ATBI, acute phase, PTA/PTAS This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

“…Ye et al (24) reported a 1.4% incidence of stroke or mortality within 30 days after DES implantation in a group with moderate stenosis <70% that increases to 12.1% if the stenosis was >70%. The present study demonstrated no periprocedural strokes or death with 84.9 ± 9.6% mean baseline stenosis and deployment of the R-onyx DES in different types of lesions; anterior circulation 72.7%, posterior circulation 27.3%, and tandem intracranial lesions 16.7% of procedures (Figure 1).…”

Section: -Month Angiogram (9 Patients)mentioning

confidence: 99%

“…Because ISR is associated with a high rate of recurrent neurologic events (27), DES treatment of sICAD could be more effective especially if associated with the aforementioned risk factors. DES has less incidence of ISR (24); the underlying pathophysiological mechanism of this is inhibition of vessel overreaction after injury and reduction of neointimal thickness which is achieved by delivery of antiproliferative drugs (28).…”

Section: -Month Angiogram (9 Patients)mentioning

confidence: 99%

Initial Experience With the Next-Generation Resolute Onyx Zotarolimus-Eluting Stent in Symptomatic Intracranial Atherosclerotic Disease

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et al. 2020

Front. Neurol.

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Background and Purpose: Intracranial atherosclerotic disease (ICAD) is a common cause of stroke worldwide. Although there are different endovascular options for the treatment of symptomatic ICAD (sICAD), it is still controversial. Herein, we aim to study the safety and efficacy of a new generation of drug-eluting balloon-mounted stent (DES); Resolute (R) onyx DES in the treatment of sICAD. Methods: A prospectively maintained neuroendovascular procedures database in a high-volume comprehensive stroke center was reviewed from October 2019 through January 2020. Patients were included if they had sICAD (≥70% stenosis), failed medical management, and underwent intracranial stenting with R-onyx DES. Technical success was defined as the ability to deploy the device at the desired location and achievement of <30% residual stenosis. The primary outcome was the occurrence of complications within 72 h of the procedure (strokes, ischemic or hemorrhagic; and mortality). Secondary outcomes included rates of symptomatic and angiographic recurrence within 6 months of the procedure. Results: A total of 18 consecutive patients (mean age, 66.6 years; 44.4% were females and 94.4% were Hispanic) were eligible for the analysis. Indication for treatment was recurrent strokes in 13 and recurrent transient ischemic attack (TIA) in 5. A total of 22 symptomatic lesions with a mean baseline stenosis percent (84.9 ± 9.6) were treated using 23 R-onyx DES in 19 procedures. All procedures were done under general anesthesia with 100% technical success, and no reported periprocedural strokes or death. Among 13 patients who had clinical follow-up, 1 (7.7%) patient had TIA. There were no reported ischemic or hemorrhagic strokes. Angiographic follow-up for 9 (50%) patients showed no in-stent restenosis. Hassan et al. R-onyx DES in Treatment of sICAD Conclusion: The use of R-onyx DES in the treatment of sICAD is safe with high technical success rates. Large prospective multicenter trials with long-term follow-up are warranted.

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