Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

Abstract

Background and purposeStroke recurrence is high in patients with symptomatic intracranial stenosis despite best medical treatment. Based on evidence from past studies using previous stent generations, elective intracranial stenting (eICS) is considered in a minority of patients. This study aims to report on experience performing eICS with a novel device combination.MethodsWe retrospectively reviewed data from three high volume stroke centers and analyzed patients that were treated with eICS for symptomatic intracranial stenosis using the Acclino® (flex) stent and the NeuroSpeed® balloon catheter (Acandis GmbH, Pforzheim, Germany). Study endpoints were periprocedural rates of stroke regardless of territory or death at discharge and at the time of follow-up after eICS. Safety evaluation included asymptomatic and symptomatic intracranial hemorrhage, serious adverse events related to the intervention, and evaluation of stent patency at the time of follow-up.ResultsThe median age of patients that met the inclusion criteria (n=76) was 69 years. Target vessels were located in the anterior circulation in 55.3% (42/76) of patients. The periprocedural stroke rate was 6.5% (fatal stroke 2.6%; non-fatal stroke 3.9%) at discharge after eICS. Asymptomatic intracranial hemorrhage was observed in 5.2% (4/76) of patients. Follow-up DSA revealed in-stent restenosis of 25% (15/60), and percutaneous transluminal angioplasty was performed again in 11.6% (7/60) of patients.ConclusionStenting for symptomatic intracranial stenosis with the Acclino® (flex)/NeuroSpeed balloon® catheter seemed to be safe and reinforces eICS as an endovascular therapy option for secondary stroke prevention. Future studies are warranted to confirm these findings and investigate antithrombotic strategies and in-stent restenosis to minimize periprocedural complications and guarantee long term stent patency.

Intracranial Angioplasty with Enterprise Stent for Intracranial Atherosclerotic Stenosis: A Single-Center Experience and a Systematic Review

“…A single-center study involving 76 patients explored the effect of a new generation of closed-cell self-expandable stents, the Acclino® flex stent, in the treatment of ICAS. The incidence of stroke or death within 30 days after PTAS was 6.5%, which is similar to the results of this study [19]. Also, another study reported that using the Neuroform EZ stent to treat ICAS has the possibility of reducing complication risks.…”

“…Following the failure of the SAMMPRIS and VISSIT trials, studies on the feasibility and effectiveness of using other alternative stents to treat symptomatic ICAS have been continuing [9,[13][14][15][16][17][18][19][20]. Among the many stent options, the self-expanding Enterprise stent has been used frequently for ICAS treatment, especially in our center.…”

“…There are relatively few studies on other types of stents, so it is challenging to draw broad conclusions [18,19]. A single-center study involving 76 patients explored the effect of a new generation of closed-cell self-expandable stents, the Acclino® flex stent, in the treatment of ICAS.…”

“…Meanwhile, other stent varieties not originally designed to treat ICAS have been used for off-label treatment of ICAS. Some of these off-label stents have achieved satisfactory results, including other self-expanding stents such as the Enterprise stent (Codman Neurovascular, Raynham, Massachusetts, USA), balloon-expandable stents, and drug-eluting stents [9,[13][14][15][16][17][18][19][20]. Among these varieties, the Enterprise stent, which has a closed-cell design, special bearing system, and lower radial force, provides an attractive option to treat ICAS [9,[13][14][15][16][17].…”

Drug-Coated Balloons for the Treatment of Symptomatic Intracranial High-Grade Stenosis: A Review of the Current Rationale

“…The introduction of the first-balloon-then-stent technique with the novel self-expanding Credo stent (Acandis, Pforzheim, Germany) together with the NeuroSpeed balloon-catheter system (Acandis, Pforzheim, Germany) may further reduce the perinterventional complication rate ( 28 ). In a cohort of 76 ICAD patients treated with another new-generation, self-expanding stent system [Acclino stent/NeuroSpeed balloon catheter system (Acandis, Pforzheim, Germany)], feasibility and safety were promising with a periprocedural stroke rate of 6.5% ( 29 ). Thus, novel stent technologies as well as new procedural techniques may further reduce the overall morbidity and mortality in ICAD stenting in the future.…”