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Indications and Applications of Arterial Stents for Stroke Prevention in Atherosclerotic Intracranial Stenosis

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Abstract

Intracranial stenosis accounts for 8–10% of all ischemic strokes in North America, a frequency slightly less than that of extracranial carotid stenosis. Among patients presenting with transient ischemic attack or stroke due to intracranial stenosis, the risk of recurrent stroke in the first year after initial symptoms is about 14%. Those with high-risk features (recent stroke and severe stenosis) have up to a 23% rate of recurrent stroke in the year after their initial event. Angioplasty with stenting has emerged as a potential treatment strategy, particularly in high-risk patients, although evidence is currently limited to uncontrolled prospective trials and retrospective case series. In this article, we critically review the clinical results supporting the use of stenting and highlight some key considerations in the application of this technology, including patient selection, procedural management, technical issues, and risk factors for complications and in-stent restenosis.

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Abbreviations

GESICA:

Groupe d’Etude des Stenoses Intra-Craniennes Atheromateuses Symptomatiques

SAMMPRIS:

Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis

SSYLVIA:

Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries

VISSIT:

Vitesse Intracranial Stent Study for Ischemic Therapy

WASID:

Warfarin-Aspirin Symptomatic Intracranial Disease

WFITN:

World Federation of Interventional Therapeutic Neuroradiology

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Disclosure

Dr. Stanley Barnwell is a consultant for Boston Scientific and Micrus Endovascular Corp. No other potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Departments of Neurology and Interventional Neuroradiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR-127, Portland, OR, 97239, USA

    Jeremy D. Fields, Wayne M. Clark & Helmi L. Lutsep

  2. Departments of Neurosurgery and Interventional Neuroradiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR-127, Portland, OR, 97239, USA

    Kenneth C. Liu & Stanley L. Barnwell

Authors
  1. Jeremy D. Fields
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  2. Kenneth C. Liu
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Correspondence to Jeremy D. Fields.

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Fields, J.D., Liu, K.C., Barnwell, S.L. et al. Indications and Applications of Arterial Stents for Stroke Prevention in Atherosclerotic Intracranial Stenosis. Curr Cardiol Rep 12, 20–28 (2010). https://doi.org/10.1007/s11886-009-0070-4

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