Intracranial arterial stenting for symptomatic stenoses: a Latin American experience

Freitas, José Maria Modenesi; Zenteno, Marco; Aburto-Murrieta, Yolanda; Koppe, Gelson Luis; Abath, Carlos; Nunes, Jorge Luiz Silva; Raupp, Eduardo; Hidalgo, Raquel Cristina Trovo; Pieruccetti, Marco Antonio; Lee, Ángel

doi:10.1016/j.surneu.2006.11.062

Cited by 37 publications

(13 citation statements)

References 19 publications

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“…The first, a retrospective multicenter study by Freitas et al, 9 examined the efficacy of the Pharos stent in 32 patients with at least 50% intracranial stenosis, all of whom were symptomatic despite medical therapy except 2 asymptomatic patients. Technical success was achieved in 31 patients (97%) with 2 periprocedural complications (6%), one of which was symptomatic.…”

Section: Pharos Stentmentioning

confidence: 99%

Applications of stenting for intracranial atherosclerosis

Ding

Liu²

2011

FOC

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Intracranial atherosclerosis presents a therapeutic challenge to medical and surgical physicians alike. Despite maximal medical therapy, the stroke rate from this disease is still high, especially when arterial stenosis is severe and patients are symptomatic. Open surgical therapy has yet to be shown to be a more efficacious treatment than medical therapy alone, largely due to the relatively high rates of perioperative complications. Angioplasty has a similar fate, with the risk of periprocedural complications outweighing the overall benefit of treatment. With the advent of stents for use in intracranial vasculature, new hope has arisen for the treatment of intracranial atherosclerosis. The NEUROLINK system, the drug-eluting stents Taxus and Cypher, the flexible Wingspan stent, the Apollo stent, and the Pharos stent have all been used in various prospective and retrospective clinical studies with varying technical and clinical results. The authors' objective is to review and loosely compare the data presented for each of these stenting systems. While the Wingspan stent appears to have somewhat of an advantage with regard to technical success in comparison with the other stenting systems, the clinical follow-up time of its studies is too short to properly compare its complication rates with those of other stents. Before we continue to move forward with stenting for intracranial stenosis, a randomized prospective trial is ultimately needed to directly compare intracranial stenting to medical therapy.

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Section: Pharos Stentmentioning

confidence: 99%

Applications of stenting for intracranial atherosclerosis

Ding

Liu²

2011

FOC

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“…The 30-day clinical followup revealed 2 patients who had suffered ipsilateral stroke and 3 patients who had died, though 2 of the deaths were likely due to medication noncompliance. Ten-month clinical followup, however, revealed no additional strokes or deaths, and only four clinically silent restenosis [19]. A second study from Germany enrolled 21 patients with >70% stenosis, 7 of which were treated in the setting of acute stroke.…”

Section: Resultsmentioning

confidence: 99%

The Evolving Paradigm in the Management of Intracranial Atherosclerotic Disease

Öztürk

Bulsara

2012

International Journal of Vascular Medicine

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Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke worldwide and represents a significant health problem. The pathogenesis and natural history of ICAD are poorly understood, and rigorous treatment paradigms do not exist as they do for extracranial atherosclerosis. Currently, the best treatment for ICAD remains aspirin therapy, but many patients who are placed on aspirin continue to experience recurrent strokes. As microsurgical and endovascular techniques continue to evolve, the role of extracranial to intracranial bypass operations and stenting are increasingly being reconsidered. We performed a PubMed review of the English literature with a particular focus on treatment options for ICAD and present evidence-based data for the role of surgery and stenting in ICAD against medical therapy alone.

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“…This is similar to the rates of success described in other studies using balloon mounted stents. 7,8 The authors show that periprocedural complication rate was 10.1%, but only an additional 2.9% of patients developed stroke or death at 24-month follow-up. This is similar to the findings of the SSYLVIA study where there was a 7.2% periprocedural rate of stroke, and at 1 year an additional 3.7% of patients were found to develop an ipsilateral stroke.…”

mentioning

confidence: 99%

“…With improving technology, the rates of successful delivery appear to be increasing with reports of success as high as 92% to 96%. 7,8 The Wingspan stent system (Boston Scientific Corp) is a self-expanding stent that has been shown to also have a high success rate of delivery to the intracranial vasculature. 9,10 There have been concerns over the high rate of restenosis (30%) 11 associated with the Wingspan Stent, and some have argued that it may not be beneficial to place the stent after the angioplasty 12 as there is not a substantial luminal gain (44% residual stenosis postangioplasty to 27% post-stent placement).…”

mentioning

confidence: 99%