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Complication rates using balloon-expandable and self-expanding stents for the treatment of intracranial atherosclerotic stenoses

Analysis of the INTRASTENT multicentric registry

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

Using balloon-expandable stents (BES) for treatment of intracranial stenoses, high inflation pressures and rigidity of the device are regarded as major drawbacks limiting feasibility and safety of the procedure. Self-expanding stents (SES) were developed to facilitate lesion access and to allow for less aggressive dilatation. We analyzed data of the INTRASTENT multicentric registry to assess whether self-expanding stents significantly reduced peri-interventional complication rates.

Methods

Records of intracranial stent procedures were entered consecutively into the registry. Datasets were divided into two groups according to the type of stent used. For outcome measurement, we chose three categories: TIA/minor stroke [modified Rankin score (mRS) <2], disabling stroke, and patient death. Clinical outcome was compared between BES and SES. We analyzed types of adverse events occurring in each group in addition.

Results

Of 409 atherosclerotic lesions, 254 were treated with BES and 155 with SES. Technical success rates were 97.6% and 98.7%, respectively. Adverse event rates were 4.9%, 3.7%, and 0.8% for TIA/nondisabling stroke, disabling stroke, and death in the BES group compared with 5.3%, 6.0%, and 4.0% in the SES group. The differences were not statistically significant. We observed more perforator strokes after use of BES, but thromboembolic events occurred more often in the SES treatment group.

Conclusion

Data of the INTRASTENT registry do not support the hypothesis that introduction of SES lowered the overall complication rate of intracranial stent procedures. There might be an advantage using self-expanding stents in vessel segments with important perforating arteries.

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Acknowledgments

We thank the collaborators of the INTRASTENT study group.

In Germany:

From the University of Frankfurt, we thank W. Kurre, J. Berkefeld, M. Sitzer, T. Neumann-Haefelin, and M. Lorenz; from the University of Göttingen, M. Knauth, S. Pilgram-Pastor, R. Schramm, and J.H. Buhk; from AK Altona Hamburg, B. Eckert, A. Leppien; from the Asklepios Klinik Barmbek Hamburg, R. Brüning and T. Fitting; from the University of Hamburg, J. Fiehler and O. Wittkugel; from the University of Düsseldorf, B. Turowski; from the University of Dresden, R. v. Kummer, D. Mucha, and V. Pütz; from the University of Kiel, O. Jansen, and M. Tietke; from Wedau Kliniken Duisburg, F. Brassel, D. Meila, and S. Schotes; from the University of Mainz, W. Müller-Forell; from the University Hospital Rechts der Isar Munich, Th. Liebig, and F. Dorn; from the University of Marburg, I. Kureck; and from Helios Klinikum Erfurt, J. Klisch and V. Sychra.

In Austria:

From Landesnervenklinik Wagner-Jauregg Linz, we thank J. Trenkler, M. Sonnberger, and H.P. Haring; and University of Graz, G.E. Klein, T. Mikolits, K. Niederkorn, and S. Horner.

In Great Britain:

From the University of Oxford, we thank W. Kueker.

In Greece:

From the Papanikolaou General Hospital Thessaloniki, we thank V. Katsaridis.

In Czechoslovakia:

From the Central Military Hospital Prague, we thank J. Maskova and H. Parobkova.

Conflict of interest

W. Kurre has received a modest Speaker's Honoraria from Micrus Endovascular. J. Berkefeld has received modest honoraria as a Consultant of Micrus Endovascular. B. Eckert has received modest Speaker's honoraria from Boston Scientific.

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Authors and Affiliations

  1. Department of Neuroradiology, Alfried Krupp Krankenhaus, Alfried Krupp Strasse 21, 45131, Essen, Germany

    Wiebke Kurre

  2. Department of Neuroradiology, Goethe Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany

    Joachim Berkefeld

  3. Department of Radiology, Wedau Kliniken, Zu den Rehwiesen 9-11, 47055, Duisburg, Germany

    Friedhelm Brassel

  4. Department of Radiology, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Germany

    Roland Brüning

  5. Department of Neuroradiology, Georg August Universität Göttingen, Robert Koch Strasse 40, 37075, Göttingen, Germany

    Jan Buhk & Michael Knauth

  6. Department of Radiology, Asklepios Klinik Altona, Paul-Ehrlich-Strasse 1, 22763, Hamburg, Germany

    Bernd Eckert

  7. Department of Neurology, Universitätsklinik Graz, Auenbruggerplatz 22, 8036, Graz, Austria

    Susanna Horner

  8. Department of Neuroradiology, Klinikum Rechts der Isar, Ismainger Strasse 22, 81675, München, Germany

    Thomas Liebig

  9. Central Military Hospital, Prague, Czechoslovakia

    Jana Maskova

  10. Department of Neuroradiology, Universitätsklinik Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

    Dirk Mucha

  11. Department of Neuroradiology, Landesnervenklinik Wagner Jauregg, Wagner Jauregg Weg 15, 4020, Linz, Austria

    Michael Sonnberger & Johannes Trenkler

  12. Department of Neuroradiology, Helios Klinikum Erfurt, Nordhäuser Strasse 74, 99089, Erfurt, Germany

    Vojtech Sychra

  13. Department of Neurology, Klinikum Herford, Schwarzenmoorstraße 70, 32049, Herford, Germany

    Matthias Sitzer

  14. Department of Neuroradiology, University of Kiel, Arnold Heller Strasse 3, 24105, Kiel, Germany

    Marc Tietke

  15. Department of Neuroradiology, University of Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany

    Bernd Turowski

Authors
  1. Wiebke Kurre
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  2. Friedhelm Brassel
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  3. Roland Brüning
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  5. Bernd Eckert
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  6. Susanna Horner
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  7. Michael Knauth
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  8. Thomas Liebig
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  9. Jana Maskova
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  10. Dirk Mucha
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  13. Michael Sonnberger
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  15. Johannes Trenkler
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  17. Joachim Berkefeld
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INTRASTENT study group

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Correspondence to Wiebke Kurre.

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Kurre, W., Brassel, F., Brüning, R. et al. Complication rates using balloon-expandable and self-expanding stents for the treatment of intracranial atherosclerotic stenoses. Neuroradiology 54, 43–50 (2012). https://doi.org/10.1007/s00234-010-0826-y

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  • DOI: https://doi.org/10.1007/s00234-010-0826-y

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