Stenting for Symptomatic Intracranial Vertebrobasilar Artery Stenosis in Northeast of China: A Single-Center Study

Abstract

Objective: We described the incidence of surgery-related complications to evaluate the safety of endovascular therapy for severe symptomatic intracranial vertebral basilar artery stenosis (IVBS) in our stroke center in Northeast of China.Methods: Consecutive patients with symptomatic IVBS caused by 70–99% stenosis despite standard medical treatment of antiplatelet agents plus statin were enrolled. Either balloon-mounted stent or balloon predilation plus self-expanding stent was performed. Clinical adverse events such as stroke, transient ischemic attack (TIA), and death after the surgery were documented. Radiological events such as in-stent thrombosis, dissection, and guide-wire perforation during the process were recorded as complications as well. The baseline characteristics and outcomes of patients among different Mori types were compared.Results: From January 2017 to December 2018, 97 patients with stroke or TIA due to intracranial IVBS were treated by stenting, including 30 patients with basilar artery (BA) stenosis, 55 patients with intracranial vertebral artery (V4) stenosis, and 12 patients with V4-BA stenosis. The primary events include two intracranial hemorrhage (2.1%, 2/97), seven ischemic events (7.2%, 7/97), and two death (2.1%, 2/97). The successful stent deployment rate was 98.9% (96/97). The Apollo stents were used more for Mori A lesions. Self-expanding stents were more used in Mori C lesions. Mori C lesions were more vulnerable to endovascular procedure and showed higher rate of complications than A (p = 0.008) and B type (p = 0.047).Conclusion: A high technical success rate of IVBS stenting could be achieved, and the safety was acceptable, whereas Mori C lesions were more vulnerable to endovascular procedure and showed a higher rate of complications than A and B types.

Self‐expanding versus balloon expandable stent for intracranial arterial stenosis: A systematic review and meta‐analysis

“…Of the excluded studies, four of the studies 10,[34][35][36] had overlapping patient databases and two of the studies included outcomes that could not be differentiated between the two stent types. 37,38 A total of studies were included, all of them were nonrandomized observational studies.…”

“…We also noticed funnel plot asymmetry in all the endpoints ascertained which can be a result of publication or other reporting biases, heterogeneity, and chance. 37,38 We used random effects model to account for heterogeneity and performed subgroup analysis or meta-regression by study design and characteristics as recommended by Metelli and Chaimani. 60 However, due to the small number of studies, our meta-regression was limited since a large ratio of studies to a covariate is required for a meaningful analysis.…”

Balloon-mounting stent for intracranial arterial stenosis: A comprehensive and comparative systematic review and meta-analysis

“…Results showed that BMS could significantly reduce the degree of stenosis compared to SES (Difference in means 5.95, P-value 0/00, and CI 95% −7.27 to −4. 19).…”

Basilar artery occlusion: A review of clinicoradiologic features, treatment selection, and endovascular techniques

“…A higher rate of complications were noted with Mori C lesions compared to Mori A (p = 0.008) and Mori B (p = 0.047). 68,69 Another multi-center prospective registry by Miao et al assessed the safety and efficacy of stenting within 30 days for patients with severe symptomatic stenosis (defined as 70-99%). Among the 159 patients treated with balloon mounted stents, 48 patients had basilar artery stenosis and 48 patients had intracranial vertebral artery stenosis.…”