Thirty-Day Outcome of a Multicenter Registry Study of Stenting for Symptomatic Intracranial Artery Stenosis in China

Abstract

Background and Purpose-Although recent trials have suggested that stenting is worse than medical therapy for patients with severe symptomatic intracranial atherosclerotic stenosis, it is not clear whether this conclusion applies to a subset of patients with hypoperfusion symptoms. To justify for a new trial in China, we performed a multicenter prospective registry study to evaluate the safety and efficacy of endovascular stenting within 30 days for patients with severe symptomatic intracranial atherosclerotic stenosis. Methods-Patients with symptomatic intracranial atherosclerotic stenosis caused by 70% to 99% stenosis combined with poor collaterals were enrolled. The patients were treated either with balloon-mounted stent or with balloon predilation plus self-expanding stent as determined by the operators following a guideline. The primary outcome within 30 days is stroke, transient ischemic attack, and death after stenting. The secondary outcome is successful revascularization. The baseline characteristics and outcomes of the 2 treatment groups were compared. Results-From September 2013 to January 2015, among 354 consecutive patients, 300 patients (aged 58.3±9.78 years) were recruited, including 159 patients treated with balloon-mounted stent and 141 patients with balloon plus self-expanding stent. The 30-day rate of stroke, transient ischemic attack, and death was 4.3%. Successful revascularization was 97.3%. Patients treated with balloon-mounted stent were older, less likely to have middle cerebral artery lesions, more likely to have vertebral artery lesions, more likely to have Mori A lesions, less likely to have Mori C lesions, and likely to have lower degree of residual stenosis than patients treated with balloon plus self-expanding stent. Conclusions-The short-term safety and efficacy of endovascular stenting for patients with severe symptomatic intracranial atherosclerotic stenosis in China is acceptable. Balloon-mounted stent may have lower degree of residual stenosis than self-expanding stent. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01968122.

Current Status and Future Perspective of Stenting for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis

“…Tailored endovascular treatment of using balloon-mounted stent or balloon plus self-expanding stent for ICAD was based on anatomical features and lesion morphology. The 30-day rate of stroke, TIA, and death was 4.3% (13/300) [22]. Gao et al enrolled patients with recent TIA or ischemic stroke related to high-grade stenosis of a major intracranial artery and with distal hypoperfusion and/or cortical involvement but excluded patients who had ischemic symptoms within the recent 3 weeks and perforator ischemic events.…”

The experiences of balloon-expandable stent in symptomatic stenosis of middle cerebral artery

“…The VISSIT trial did not support the use of BES (Zaidat et al 2015). Nevertheless, Miao revealed the safety and efficacy of endovascular stenting (Miao et al 2015). The reporters found that there was no significant difference between the SES and the BES about the follow-up clinical outcomes (Yue et al 2011b).…”

“…The problem was resolved by the BES. BES may have a lower degree of residual stenosis than SES (Miao et al 2015). We obtained an outstanding angiographic result with BES.…”

“…But the SAMMPRIS trial (Chimowitz et al 2011) and the VISSIT trial (Zaidat et al 2015) revealed the negative results. Recently, the safety and efficacy were certified again (Miao et al 2015). …”

Angioplasty and stenting for patients with symptomatic intracranial atherosclerosis: study protocol of a randomised controlled trial

“…15 16 The first one was a single-centre randomised trial, the results of which demonstrated that PTAS is as effective as medical treatment 16. The result of the second study, a multicentre registry study, showed that the incidence of stroke, transient ischaemic attack (TIA) and death in 30 days after stenting was 4.3%, which is lower than the incidence in the SAMMPRIS trial 17. The third study was a retrospective study.…”