Neurological Research

2005

DOI: 10.1179/016164105x35495

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Endovascular reconstruction by means of stent placement in symptomatic intracranial atherosclerotic stenosis

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Abstract: In selected patients, endovascular revascularization of intracranial arteries by means of stent-assisted angioplasty is technically feasible, effective and safe.

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Siddiq Et Al Angioplasty Vs Stenting For Intracranial Athero1

Discussion1

Large Case Series1

Intracranial and Extracranial Stent Placement1

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Cited by 37 publications

(18 citation statements)

References 21 publications

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“…Marks et al 43 reported a much higher rate of significant postoperative residual stenosis in intracranial angioplasty series (18/36 cases, 50%). In contrast, Lylyk el al 44 found no significant postoperative residual stenosis in 104 intracranial stenting procedures. Our data suggest that the rates of periprocedural stroke and death were similar in both groups.…”

Section: Siddiq Et Al Angioplasty Vs Stenting For Intracranial Atheromentioning

confidence: 97%

Comparison of Primary Angioplasty With Stent Placement for Treating Symptomatic Intracranial Atherosclerotic Diseases

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et al. 2008

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Background and Purpose-We sought to compare the clinical outcomes between primary angioplasty and stent placement for symptomatic intracranial atherosclerosis. Methods-We retrospectively analyzed the clinical and angiographic data of 190 patients treated with 95 primary angioplasty procedures and 98 intracranial stent placements (total of 193 procedures) in 3 tertiary care centers. Stroke and combined stroke and/or death were identified as primary clinical end points during the periprocedural and follow-up period of 5 years. The rates of significant postoperative residual stenosis (Ն50% of greater stenosis immediately after the procedure) and binary restenosis (Ն50% stenosis at follow-up angiography within 3 years) were also compared. The comparative analysis was performed after adjusting for age, sex, and center. Results-Fourteen procedures in the angioplasty-treated group (15%) and 4 in the stent-treated group (4.1%) had significant postoperative residual stenosis (relative risk [RR]ϭ2.8, 95% CI, 0.85 to 9.5, Pϭ0.09, for the adjusted model). There were 3 periprocedural deaths (1.5%), 1 in the angioplasty group (1.1%) and 2 in the stent-treated group (2.0%) and 14 periprocedural strokes (7.3%), 7 periprocedural strokes in each group (7.4% and 7.1%, respectively; hazard ratioϭ1.1; 95% CI, 0.57 to 1.9, Pϭ0.85). Angiographic follow-up was available for 134 procedures (66 angioplastytreated and 68 stent-treated cases). Forty-eight procedures (36.1%) had evidence of binary restenosis (25 of 66 angioplasties, 23 of 68 stents, Pϭ0.85). Binary restenosis-free survival at 12 months was 68% for the angioplasty-treated group and 64% for the stent-treated group. There was no difference in follow-up survival (stroke, or stroke and/or death) between the angioplasty-treated and the stent-treated groups (hazard ratioϭ0.54; 95% CI, 0.11 to 2.5, Pϭ0.44 and hazard ratioϭ0.50; 95%, CI 0.17 to 1.5, Pϭ0.22, respectively, after adjusting for age, sex, and center). The strokeand/or death-free survival at 2 years for the angioplasty-treated group and the stent-treated group was 92Ϯ4% and 89Ϯ5%, respectively. Conclusions-Stent treatment for intracranial atherosclerosis may lower the rate of significant postoperative residual stenosis compared with primary angioplasty alone. No benefit of stent placement over primary angioplasty in reducing stroke or stroke and/or death could be identified in this study. (Stroke. 2008;39:2505-2510.)

“…Marks et al 43 reported a much higher rate of significant postoperative residual stenosis in intracranial angioplasty series (18/36 cases, 50%). In contrast, Lylyk el al 44 found no significant postoperative residual stenosis in 104 intracranial stenting procedures. Our data suggest that the rates of periprocedural stroke and death were similar in both groups.…”

Section: Siddiq Et Al Angioplasty Vs Stenting For Intracranial Atheromentioning

confidence: 97%

Comparison of Primary Angioplasty With Stent Placement for Treating Symptomatic Intracranial Atherosclerotic Diseases

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²

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et al. 2008

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Background and Purpose-We sought to compare the clinical outcomes between primary angioplasty and stent placement for symptomatic intracranial atherosclerosis. Methods-We retrospectively analyzed the clinical and angiographic data of 190 patients treated with 95 primary angioplasty procedures and 98 intracranial stent placements (total of 193 procedures) in 3 tertiary care centers. Stroke and combined stroke and/or death were identified as primary clinical end points during the periprocedural and follow-up period of 5 years. The rates of significant postoperative residual stenosis (Ն50% of greater stenosis immediately after the procedure) and binary restenosis (Ն50% stenosis at follow-up angiography within 3 years) were also compared. The comparative analysis was performed after adjusting for age, sex, and center. Results-Fourteen procedures in the angioplasty-treated group (15%) and 4 in the stent-treated group (4.1%) had significant postoperative residual stenosis (relative risk [RR]ϭ2.8, 95% CI, 0.85 to 9.5, Pϭ0.09, for the adjusted model). There were 3 periprocedural deaths (1.5%), 1 in the angioplasty group (1.1%) and 2 in the stent-treated group (2.0%) and 14 periprocedural strokes (7.3%), 7 periprocedural strokes in each group (7.4% and 7.1%, respectively; hazard ratioϭ1.1; 95% CI, 0.57 to 1.9, Pϭ0.85). Angiographic follow-up was available for 134 procedures (66 angioplastytreated and 68 stent-treated cases). Forty-eight procedures (36.1%) had evidence of binary restenosis (25 of 66 angioplasties, 23 of 68 stents, Pϭ0.85). Binary restenosis-free survival at 12 months was 68% for the angioplasty-treated group and 64% for the stent-treated group. There was no difference in follow-up survival (stroke, or stroke and/or death) between the angioplasty-treated and the stent-treated groups (hazard ratioϭ0.54; 95% CI, 0.11 to 2.5, Pϭ0.44 and hazard ratioϭ0.50; 95%, CI 0.17 to 1.5, Pϭ0.22, respectively, after adjusting for age, sex, and center). The strokeand/or death-free survival at 2 years for the angioplasty-treated group and the stent-treated group was 92Ϯ4% and 89Ϯ5%, respectively. Conclusions-Stent treatment for intracranial atherosclerosis may lower the rate of significant postoperative residual stenosis compared with primary angioplasty alone. No benefit of stent placement over primary angioplasty in reducing stroke or stroke and/or death could be identified in this study. (Stroke. 2008;39:2505-2510.)

“…In our series there was also one 79-year-old female patient with a fateful course of vessel rupture. Recently, the advent of a new generation of more flexible stents has prompted consideration of stent-assisted angioplasty as an alternative approach for treatment of intracranial stenosis [25,28].…”

Section: Discussionmentioning

confidence: 99%

Periprocedural Thromboembolic Events Associated with Angioplasty and Stenting of the Extra- and Intracranial Carotid Artery Assessed by Neurological Status and Diffusion-Weighted Magnetic Resonance Imaging (DWI)

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et al. 2012

ISRN Vascular Medicine

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Objective. The purpose of this study was to determine the frequency of thromboembolic events associated with angioplasty and stenting of the carotid artery with special regard to extra-or intracranial localization of stenosis. Methods. Twenty patients with symptomatic intracranial or extracranial internal carotid artery stenosis were treated with stenting and/or angioplasty. In 4 patients stenting was technically not feasible (all in the group with intracranial stenosis). All patients underwent diffusion-weighted imaging (DWI) and neurological examination within 48 hours before and after the procedure to detect periprocedural thrombembolic events. Results. Extracranial carotid angioplasty and stenting (eCAS) was technically feasible and successfull without procedurerelated neurological complications in all cases. Intracranial stenting (iCAS) was not feasible in four cases including one patient with a fateful course. Concerning the restoration of the vessel diameter intracranial stenting was not as successful as eCAS, but more effective than balloon angioplasty alone. Incidence of thrombembolic events assessed by DWI was low. The detected periprocedural thrombembolic events were small and clinically silent. Conclusion. The risk of thromboembolic events during the endovascular treatment of symptomatic carotid artery stenosis was rather low for intra-and extracranial stenosis of the ICA in our patient sample, but one fatal course was observed.

“…This finding led the authors to conclude that any benefit from stenting was observed primarily in the group with severe stenosis given that, based on WASID, significantly more recurrent events would have been expected in the severe stenosis group. A smaller prospective single-center study from Argentina (104 patients) reported a 5.7% procedural morbidity rate, including a 3.8% risk of death [31].…”

Section: Large Case Seriesmentioning

confidence: 99%

Indications and Applications of Arterial Stents for Stroke Prevention in Atherosclerotic Intracranial Stenosis

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et al. 2010

Curr Cardiol Rep

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Intracranial stenosis accounts for 8-10% of all ischemic strokes in North America, a frequency slightly less than that of extracranial carotid stenosis. Among patients presenting with transient ischemic attack or stroke due to intracranial stenosis, the risk of recurrent stroke in the first year after initial symptoms is about 14%. Those with high-risk features (recent stroke and severe stenosis) have up to a 23% rate of recurrent stroke in the year after their initial event. Angioplasty with stenting has emerged as a potential treatment strategy, particularly in high-risk patients, although evidence is currently limited to uncontrolled prospective trials and retrospective case series. In this article, we critically review the clinical results supporting the use of stenting and highlight some key considerations in the application of this technology, including patient selection, procedural management, technical issues, and risk factors for complications and in-stent restenosis.

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