Endovascular treatment of symptomatic intracranial atherosclerotic stenosis with low profile visualized intraluminal support stent

Tang, Haishuang; Lu, Zhijie; Zeng, Zhangwei; Zuo, Qiao; Lu, Qiang; Xu, Feifei; Huang, Qinghai; Liu, Jianmin

doi:10.1016/j.jocn.2021.06.009

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…However, flow-diverter stents may not be widely available due to their high cost for the treatment of CTO. Despite the fact that they are associated with lower radial force, braided intracranial stents like the Low Profile Visualized Intraluminal Support stent (LVIS) (MicroVention) have been successfully used for the treatment of symptomatic high-grade intracranial stenosis and may offer the same advantages as flow-diverter stents but with lower metal content (which may even reduce thrombogenicity) 25 26…”

Section: Discussionmentioning

confidence: 99%

Modern endovascular management of chronic total carotid artery occlusion: technical results and procedural challenges

Radu

Derraz

Dargazanli

et al. 2022

J NeuroIntervent Surg

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BackgroundThe optimal management of chronic total carotid artery occlusion (CTO) is still debated. Endovascular treatment is being increasingly used with heterogeneous technical and clinical results.MethodsPatients with CTO treated with modern endovascular approaches during the past several years (January 2018–December 2021) were retrospectively reviewed.ResultsTwenty patients, with a mean age of 63.7 years, were treated during the study period. Indications for treatment were recurrent stroke in 12 (60%), hemodynamic impairment in 4 (20%), and progressive stroke in 4 (20%) patients. In 6 (30%) patients, the occlusion was limited to the cervical portion, in 5 (25%) to the petrous segment, and in 9 (45%) to the cavernous segment. Technical treatment success was achieved in 80% of cases. In patients with successful recanalization, median pretreatment hypoperfusion volumes dropped from 126 mL (25–75 IQR, 33–224 mL) to 0 mL (25–75 IQR, 0–31.5 mL). Symptomatic procedure-related complications were 30% and permanent procedure-related morbidity-mortality was 5%. Early stent occlusion occurred in 5 (25%) cases. Two cases were asymptomatic and were not retreated, 3 cases presented transient symptoms of which two were successfully recanalized. Stent occlusion was not associated with permanent symptoms. In successfully recanalized patients no intraprocedural emboli were observed.ConclusionsIn the modern endovascular era, revascularization of CTO is a feasible procedure in most cases, and it may be offered in selected patients. However, the high re-occlusion rate is still a limitation of the technique, underlining the need for more research on the technical procedural and periprocedural management.

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Section: Discussionmentioning

confidence: 99%

Modern endovascular management of chronic total carotid artery occlusion: technical results and procedural challenges

Radu

Derraz

Dargazanli

et al. 2022

J NeuroIntervent Surg

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Optional or optimal? off-label stenting for intracranial atherosclerotic stenosis: A scoping review

Zhao

Wang

et al. 2023

Interv Neuroradiol

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Background Intracranial atherosclerotic stenosis is a major cause of ischemic stroke. In addition to the Wingspan stent system, several self-expanding stents have been used off-label to treat intracranial atherosclerotic stenosis lesions. The purpose of this review is to assess the existing data on the off-label use of self-expanding stents in intracranial atherosclerotic stenosis, to highlight methodological limitations in current study designs, and thus providing strategies and precautions for clinical practice. Methods The PubMed, EMBASE, and the Cochrane Library databases were systematically searched for relevant articles published up to April 2022. In addition to the meta analysis of Enterprise, Neuroform EZ and closed cell stent respectively, we used a narrative synthesis to summarize and discuss the appropriate strategies and precautions for the use of each stent. Results We identified 17 studies (1091 patients with 1124 lesions) reporting 6 types of off-label self-expanding stents. The most common endpoints reported were incidence of short-term complications (range: 0–15.8%, median: 3.8%), long-term complications (range: 0–12.0%, median: 0%). Potential risks include infeasibility of stenting hard lesions or tortuous vessels, stent migration, and in-stent thrombosis. Less is known about the conditions that are appropriate for an optimal stent (e.g., open-cell, close-cell, hybrid cell). There was considerable heterogeneity across studies with regards to study populations and study designs. Conclusions The potential risks and benefits should be carefully considered when using off-label stents for intracranial atherosclerotic stenosis, particularly given the current evidence power. As a potential option for the Wingspan stent, based on device's approval only, a tailored approach with lesion-specific devices could be beneficial in certain patients.

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A proposed modern standardized technical approach for symptomatic chronic carotid total occlusion management

Radu,

Cagnazzo,

Schiphorst

et al. 2024

Interv Neuroradiol

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Chronic carotid total occlusion (CCTO) is a known cause of ischemic stroke and transient ischemic attack. Symptomatic CCTO is associated with up to 30% risk of recurrent ischemic stroke, despite optimal medical treatment. Notably, a randomized controlled trial reported that previous surgical management did not improve the overall prognosis of these patients. Endovascular treatment of CCTO has been proposed as a feasible strategy to re-establish cerebral perfusion in symptomatic patients. However, its use is controversial and not supported by evidence from randomized clinical trials. Recently, a meta-analysis reported a reasonably high procedural success without an excess periprocedural complication rate, but several steps are needed before the procedure is mature enough to be tested in randomized controlled trials. This review highlights the developments in the endovascular recanalization of CCTO and emphasizes key steps towards standardizing the procedure.

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Endovascular treatment of symptomatic intracranial atherosclerotic stenosis with low profile visualized intraluminal support stent

Cited by 3 publications

References 25 publications

Modern endovascular management of chronic total carotid artery occlusion: technical results and procedural challenges

Modern endovascular management of chronic total carotid artery occlusion: technical results and procedural challenges

Optional or optimal? off-label stenting for intracranial atherosclerotic stenosis: A scoping review

A proposed modern standardized technical approach for symptomatic chronic carotid total occlusion management

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