Factors associated with perforator stroke after selective basilar artery angioplasty or stenting

Jia, Baixue; Liebeskind, David S; Ma, Ning; Gao, Feng; Mo, Dapeng; Luo, Gang; Li, Xiaobing; Sui, Xiaojie; Peng, Guangge; Miao, Zhongrong

doi:10.1136/neurintsurg-2016-012329

Cited by 16 publications

(11 citation statements)

References 17 publications

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“…Although the incidence of endpoint events in patients receiving intensive medication is lower than that of patients who receive intracranial stenting, the incidence of endpoint events is still high and unacceptable. The adverse events in these studies occurred after Winspan stenting, suggesting that such adverse events may be related to the open-loop design, large radial force, high head-end hardness, and severe tortuosity of Wingspan stents that make them difficult to pass through blood vessels; in addition, the Wingspan stent is difficult to operate and can easily induce perforating branch events [13]. Therefore, based on our experience in the treatment intracranial aneurysms, we chose Enterprise stents in our present study, which is a more mature stent for ICAS treatment.…”

Section: Discussionmentioning

confidence: 98%

“…The bowstring effect should be avoided when loosening the balloon and stent system intraoperatively to prevent tearing of the perforating vessels and to achieve sub-satisfactory results once the balloon is expanded [21]. Perforator stroke (PS) is one of the most common complications of intracranial angioplasty and/or stent implantation [13]. The basilar artery is the most common site of PS among all perforator-rich areas.…”

Section: Discussionmentioning

confidence: 99%

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Medium- and long-term effects of endovascular treatments for severely stenotic basilar arteries supported by multimodal imaging

Song

et al. 2020

BMC Neurol

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Background: To evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging. Method: After strict screening of 67 patients with symptomatic severe basilar artery stenosis (70-99%) with atherosclerotic stenosis, 67 patients with symptomatic recurrence after intensive drug treatment were treated with intravascular balloon dilatation and Enterprise stent implantation. Any stroke or death within 30 days after operation and any stroke and restenosis during medium-and long-term follow-up were recorded. Results: ①The mean age of 67 patients (67lesions) was 57 ± 8 years old, and the technical success rate was 100%; ②Preoperative angiography showed that the collateral circulation was poor, and TICI was 1-2a while postoperative angiography showed that TICI was significantly improved to 2b-3; ③The average preoperative stenosis rate was 82 ± 9%, and the postoperative stenosis rate was reduced to 17 ± 10%; ④Before surgery, abnormal perfusion was found in the posterior circulation CTP; After the postoperative re-examination, the posterior circulation of CTP perfusion was significantly improved; ⑤Postoperative symptoms and neurological conditions improved significantly; ⑥Complications of perforating branch event occurred in 1 case after operation, and symptoms were relieved after more than 1 month of medication treatment, and mild neurological dysfunction remained. 1 case developed subacute thrombosis in the stent, which improved after active intra-arterial thrombolysis, and there was no residual neurological dysfunction; and 1 case of micro-guide wire being trapped by the distal vasospasm. ⑦67 patients were followed up by telephone, WeChat or imaging for 36-66 months.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Medium- and long-term effects of endovascular treatments for severely stenotic basilar arteries supported by multimodal imaging

Song

et al. 2020

BMC Neurol

View full text Add to dashboard Cite

show abstract

“…The bowstring effect should be avoided when loosening the balloon and stent system intraoperatively to prevent tearing of the perforating vessels and to achieve sub-satisfactory results once the balloon is expanded [21] . Perforator stroke (PS) is one of the most common complications of intracranial angioplasty and/or stent implantation [22] . The basilar artery is the most common site of PS among all perforator-rich areas.…”

Section: Discussionmentioning

confidence: 99%

Medium- and Long-Term Effects of Endovascular Treatments for Severely Stenotic Basilar Arteries Supported by Multimodal Imaging

Xie

Gong

et al. 2020

Preprint

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Background: To evaluate the medium-and long-term effect of intravascular interventional therapy for symptomatic severe basilar artery stenosis supported by multimodal imaging.Method: After strict screening of 67 patients with symptomatic severe basilar artery stenosis (70%- 99%) with atherosclerotic stenosis, 67 patients with symptomatic recurrence after intensive drug treatment were treated with intravascular balloon dilatation and Enterprise stent implantation. Any stroke or death within 30 days after operation and any stroke and restenosis during medium-and long-term follow-up were followed up.Results: The mean age of 67 patients(67lesions) was 57 ± 8 years old, and the technical success rate was 100%; ②Preoperative angiography showed that the collateral circulation was poor, and TICI was 1-2a while postoperative angiography showed that TICI was significantly improved to 2b-3; ③The average preoperative stenosis rate was 82 ± 9%, and the postoperative stenosis rate was reduced to 17 ± 10%; ④Before surgery, abnormal perfusion was found in the posterior circulation CTP; After the postoperative re-examination, the posterior circulation of CTP perfusion was significantly improved; ⑤Postoperative symptoms and neurological conditions improved significantly; ⑥Complications of perforating branch event occurred in 1 case after operation, and symptoms were relieved after more than 1 month of active treatment, and mild neurological dysfunction remained. 1 case developed subacute thrombosis in the stent, which improved after active intra-arterial thrombolysis, and there was no residual neurological dysfunction; and 1 case of microlead wire being clamped by the distal vasospasm. ⑦67 patients were followed up by telephone, WeChat or imaging for 36–66 months. 55 cases were regularly reviewed with images. Intrastenting stenosis occurred in 4 cases, and 12 cases were followed up by phone or WeChat.The average follow-up period was 56 ± 21 months (36–66 months). No TIA or stroke occurred during follow-up.Conclusions: In summary intravascular balloon dilation + Enterprise stent implantation is safe and effective for the treatment of symptomatic severe atherosclerotic stenosis of the basilar artery, with high technical success rate, low perioperative complications, and good mid-term and long-term effects.

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“…Time from last symptom to procedure may affect the risk of perforator stroke associated with intracranial artery angioplasty and/or stenting. The time from last symptom to procedure of <18 days is a risk factor to induce perforator stroke 16. The plaques lying in the stenosis artery are unstable in the acute stage and the ‘snowplowing’ effect of intracranial stenting could result in periprocedural perforator stroke 17.…”

Section: Discussionmentioning

confidence: 99%

Early versus delayed stenting for intracranial atherosclerotic artery stenosis with ischemic stroke

Zhang

Sun

et al. 2019

J NeuroIntervent Surg

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ObjectiveTo evaluate the clinical outcomes of early stenting (≤14 days) or late stenting (>14 days) in patients who underwent intracranial stent placement.MethodsPatients with ischemic stroke caused by 70–99% intracranial atherosclerotic stenosis combined with poor collaterals were enrolled. The early stenting group, who underwent stenting within 14 days of last ischemic symptoms, were compared with the late stenting group who underwent stenting >14 days from last ischemic symptom. The patients were treated either with a balloon-mounted stent or a self-expanding stent as determined by the operators following a guideline. The baseline characteristics and clinical outcomes were evaluated and compared.ResultsOne hundred and fifteen stroke patients were recruited into the study. Four patients (4/41) in the early stenting group and two patients (2/74) in the late stenting group were diagnosed with a cerebral vascular event associated with stenting within 3 days (p=0.184). In the long-term follow-up, eight patients in the early stenting group had restenosis ≥50%, which was higher than patients in the late stenting group (8/41 vs 4/74, p=0.018). The total rates of any ischemic stroke, transient ischemic attack, hemorrhagic stroke, and death in the early stenting group were higher than in the late stenting group (9/41 vs 6/74, p=0.035). The recurrence rate of ischemic stroke in the early stenting group was higher than in the late stenting group (5/41 vs 2/74, p=0.041).ConclusionsStent placement in the setting of ischemic stroke caused by intracranial artery stenosis within 14 days may confer a higher risk of long-time cerebral vascular events and lead to a higher risk of restenosis.Clinical trial registrationNCT01968122.

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Factors associated with perforator stroke after selective basilar artery angioplasty or stenting

Cited by 16 publications

References 17 publications

Medium- and long-term effects of endovascular treatments for severely stenotic basilar arteries supported by multimodal imaging

Medium- and long-term effects of endovascular treatments for severely stenotic basilar arteries supported by multimodal imaging

Medium- and Long-Term Effects of Endovascular Treatments for Severely Stenotic Basilar Arteries Supported by Multimodal Imaging

Early versus delayed stenting for intracranial atherosclerotic artery stenosis with ischemic stroke

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