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Endovascular Treatment of Intracranial Atherosclerosis

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Neurointervention in the Medical Specialties

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Intracranial atherosclerotic disease (ICAD) is responsible for a significant proportion of ischemic strokes worldwide. Conservative medical management is the appropriate first step in the treatment of ICAD. The clinical presentation of ICAD is heterogeneous, with ischemia resulting from more than one mechanism. Delineating the mechanism of ischemia needs careful clinical analysis and usually necessitates multimodal imaging. An endovascular treatment approach based on the mechanism of stroke may be beneficial for select patients. Patient selection will be a critical factor in the design of future ICAD clinical trials.

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References

  1. Lee JS, Im DS, An YS, Hong JM, Gwag BJ, Joo IS. Chronic cerebral hypoperfusion in a mouse model of Alzheimer’s disease: an additional contributing factor of cognitive impairment. Neurosci Lett. 2011;489:84–8.

    Article  CAS  PubMed  Google Scholar 

  2. Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke. 1995;26:14–20.

    Article  CAS  PubMed  Google Scholar 

  3. Chimowitz MI, Lynn MJ, Derdeyn CP, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365:993–1003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Wong LK. Global burden of intracranial atherosclerosis. Int J Stroke. 2006;1:158–9.

    Article  PubMed  Google Scholar 

  5. Choi HY, Ye BS, Ahn SH, et al. Characteristics and the fate of intraluminal thrombus of the intracranial and extracranial cerebral arteries in acute ischemic stroke patients. Eur Neurol. 2009;62:72–8.

    Article  PubMed  Google Scholar 

  6. Chaturvedi S, Turan TN, Lynn MJ, et al. Risk factor status and vascular events in patients with symptomatic intracranial stenosis. Neurology. 2007;69:2063–8.

    Article  CAS  PubMed  Google Scholar 

  7. Adams GJ, Greene J, Vick GW 3rd, et al. Tracking regression and progression of atherosclerosis in human carotid arteries using high-resolution magnetic resonance imaging. Magn Reson Imaging. 2004;22:1249–58.

    Article  PubMed  Google Scholar 

  8. Carson AP, Howard G, Burke GL, Shea S, Levitan EB, Muntner P. Ethnic differences in hypertension incidence among middle-aged and older adults: the multi-ethnic study of atherosclerosis. Hypertension. 2011;57:1101–7.

    Article  CAS  PubMed  Google Scholar 

  9. Bley TA, Uhl M, Venhoff N, Thoden J, Langer M, Markl M. 3-T MRI reveals cranial and thoracic inflammatory changes in giant cell arteritis. Clin Rheumatol. 2007;26:448–50.

    Article  CAS  PubMed  Google Scholar 

  10. Waddy SP, Cotsonis G, Lynn MJ, et al. Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis. Stroke. 2009;40:719–25.

    Article  PubMed  Google Scholar 

  11. Liebeskind DS, Cotsonis GA, Saver JL, et al. Collaterals dramatically alter stroke risk in intracranial atherosclerosis. Ann Neurol. 2011;69:963–74.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stevens J, Truesdale KP, Katz EG, Cai J. Impact of body mass index on incident hypertension and diabetes in Chinese Asians, American Whites, and American Blacks: the People’s Republic of China Study and the Atherosclerosis Risk in Communities Study. Am J Epidemiol. 2008;167:1365–74.

    Article  PubMed  Google Scholar 

  13. Caplan LR. Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology. 1989;39:1246–50.

    Article  CAS  PubMed  Google Scholar 

  14. Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol. 1998;55:1475–82.

    Article  CAS  PubMed  Google Scholar 

  15. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352:1305–16.

    Article  CAS  PubMed  Google Scholar 

  16. Lee DK, Kim JS, Kwon SU, Yoo SH, Kang DW. Lesion patterns and stroke mechanism in atherosclerotic middle cerebral artery disease: early diffusion-weighted imaging study. Stroke. 2005;36:2583–8.

    Article  PubMed  Google Scholar 

  17. Ryoo S, Park JH, Kim SJ, et al. Branch occlusive disease: clinical and magnetic resonance angiography findings. Neurology. 2012;78:888–96.

    Article  CAS  PubMed  Google Scholar 

  18. Holmstedt CA, Turan TN, Chimowitz MI. Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol. 2013;12:1106–14.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kasner SE, Chimowitz MI, Lynn MJ, et al. Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation. 2006;113:555–63.

    Article  PubMed  Google Scholar 

  20. Derdeyn CP, Chimowitz MI, Lynn MJ, et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet. 2014;383:333–41.

    Article  PubMed  Google Scholar 

  21. Khan A, Kasner SE, Lynn MJ, Chimowitz MI, Warfarin Aspirin Symptomatic Intracranial Disease Trial I. Risk factors and outcome of patients with symptomatic intracranial stenosis presenting with lacunar stroke. Stroke. 2012;43:1230–3.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ois A, Gomis M, Rodriguez-Campello A, et al. Factors associated with a high risk of recurrence in patients with transient ischemic attack or minor stroke. Stroke. 2008;39:1717–21.

    Article  PubMed  Google Scholar 

  23. Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI. A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol. 2000;21:643–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Kang DW, Kwon SU, Yoo SH, et al. Early recurrent ischemic lesions on diffusion-weighted imaging in symptomatic intracranial atherosclerosis. Arch Neurol. 2007;64:50–4.

    Article  PubMed  Google Scholar 

  25. Cho KH, Kang DW, Kwon SU, Kim JS. Location of single subcortical infarction due to middle cerebral artery atherosclerosis: proximal versus distal arterial stenosis. J Neurol Neurosurg Psychiatry. 2009;80:48–52.

    Article  PubMed  Google Scholar 

  26. Feldmann E, Wilterdink JL, Kosinski A, et al. The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. Neurology. 2007;68:2099–106.

    Article  CAS  PubMed  Google Scholar 

  27. Andrade SP, Brucki SM, Bueno OF, Siqueira Neto JI. Neuropsychological performance in patients with subcortical stroke. Arq Neuropsiquiatr. 2012;70:341–7.

    Article  PubMed  Google Scholar 

  28. Saczynski JS, Sigurdsson S, Jonsdottir MK, et al. Cerebral infarcts and cognitive performance: importance of location and number of infarcts. Stroke. 2009;40:677–82.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bash S, Villablanca JP, Jahan R, et al. Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. AJNR Am J Neuroradiol. 2005;26:1012–21.

    PubMed  PubMed Central  Google Scholar 

  30. Nguyen-Huynh MN, Wintermark M, English J, et al. How accurate is CT angiography in evaluating intracranial atherosclerotic disease? Stroke. 2008;39:1184–8.

    Article  PubMed  Google Scholar 

  31. Swartz RH, Bhuta SS, Farb RI, et al. Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI. Neurology. 2009;72:627–34.

    Article  CAS  PubMed  Google Scholar 

  32. Ryu CW, Jahng GH, Kim EJ, Choi WS, Yang DM. High resolution wall and lumen MRI of the middle cerebral arteries at 3 tesla. Cerebrovasc Dis. 2009;27:433–42.

    Article  PubMed  Google Scholar 

  33. Diethrich EB, Pauliina Margolis M, Reid DB, et al. Virtual histology intravascular ultrasound assessment of carotid artery disease: the Carotid Artery Plaque Virtual Histology Evaluation (CAPITAL) study. J Endovasc Therapy. 2007;14:676–86.

    Article  Google Scholar 

  34. Xu WH, Li ML, Gao S, et al. Middle cerebral artery intraplaque hemorrhage: prevalence and clinical relevance. Ann Neurol. 2012;71:195–8.

    Article  PubMed  Google Scholar 

  35. Vergouwen MD, Silver FL, Mandell DM, Mikulis DJ, Swartz RH. Eccentric narrowing and enhancement of symptomatic middle cerebral artery stenoses in patients with recent ischemic stroke. Arch Neurol. 2011;68:338–42.

    Article  PubMed  Google Scholar 

  36. Higashida RT, Furlan AJ, Roberts H, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34:e109–37.

    Article  PubMed  Google Scholar 

  37. Powers WJ, Clarke WR, Grubb RL Jr, et al. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA. 2011;306:1983–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Group EIBS. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med. 1985;313:1191–200.

    Article  Google Scholar 

  39. Mazighi M, Tanasescu R, Ducrocq X, et al. Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study. Neurology. 2006;66:1187–91.

    Article  CAS  PubMed  Google Scholar 

  40. Marks MP, Marcellus ML, Do HM, et al. Intracranial angioplasty without stenting for symptomatic atherosclerotic stenosis: long-term follow-up. AJNR Am J Neuroradiol. 2005;26:525–30.

    PubMed  PubMed Central  Google Scholar 

  41. Marks MP, Wojak JC, Al-Ali F, et al. Angioplasty for symptomatic intracranial stenosis: clinical outcome. Stroke. 2006;37:1016–20.

    Article  PubMed  Google Scholar 

  42. Castaneda-Zuniga WR, Formanek A, Tadavarthy M, et al. The mechanism of balloon angioplasty. Radiology. 1980;135:565–71.

    Article  CAS  PubMed  Google Scholar 

  43. Sundt TM Jr, Smith HC, Campbell JK, Vlietstra RE, Cucchiara RF, Stanson AW. Transluminal angioplasty for basilar artery stenosis. Mayo Clin Proc. 1980;55:673–80.

    PubMed  Google Scholar 

  44. Takis C, Kwan ES, Pessin MS, Jacobs DH, Caplan LR. Intracranial angioplasty: experience and complications. AJNR Am J Neuroradiol. 1997;18:1661–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Purdy PD, Devous MD Sr, Unwin DH, Giller CA, Batjer HH. Angioplasty of an atherosclerotic middle cerebral artery associated with improvement in regional cerebral blood flow. AJNR Am J Neuroradiol. 1990;11:878–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. O’Leary DH, Clouse ME. Percutaneous transluminal angioplasty of the cavernous carotid artery for recurrent ischemia. AJNR Am J Neuroradiol. 1984;5:644–5.

    PubMed  PubMed Central  Google Scholar 

  47. Johnston SC, Selvin S, Gress DR. The burden, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology. 1998;50:1413–8.

    Article  CAS  PubMed  Google Scholar 

  48. Miao Z, Jiang L, Wu H, et al. Randomized controlled trial of symptomatic middle cerebral artery stenosis: endovascular versus medical therapy in a Chinese population. Stroke. 2012;43:3284–90.

    Article  PubMed  Google Scholar 

  49. Zaidat OO, Castonguay AC, Nguyen TN, et al. Impact of SAMMPRIS on the future of intracranial atherosclerotic disease management: polling results from the ICAD symposium at the International Stroke Conference. J Neurointervent Surg. 2014;6:225–30.

    Article  Google Scholar 

  50. Zaidat OO, Klucznik R, Alexander MJ, et al. The NIH registry on use of the Wingspan stent for symptomatic 70–99% intracranial arterial stenosis. Neurology. 2008;70:1518–24.

    Article  CAS  PubMed  Google Scholar 

  51. Siddiq F, Vazquez G, Memon MZ, et al. Comparison of primary angioplasty with stent placement for treating symptomatic intracranial atherosclerotic diseases: a multicenter study. Stroke. 2008;39:2505–10.

    Article  PubMed  Google Scholar 

  52. Qureshi AI, Kirmani JF, Hussein HM, et al. Early and intermediate-term outcomes with drug-eluting stents in high-risk patients with symptomatic intracranial stenosis. Neurosurgery. 2006;59:1044–51. discussion 1051

    Article  PubMed  Google Scholar 

  53. Abou-Chebl A, Bashir Q, Yadav JS. Drug-eluting stents for the treatment of intracranial atherosclerosis: initial experience and midterm angiographic follow-up. Stroke. 2005;36:e165–8.

    Article  CAS  PubMed  Google Scholar 

  54. Boulos AS, Agner C, Deshaies EM. Preliminary evidence supporting the safety of drug-eluting stents in neurovascular disease. Neurol Res. 2005;27(Suppl 1):S95–102.

    Article  PubMed  Google Scholar 

  55. Nguyen TN, Zaidat OO, Gupta R, et al. Balloon angioplasty for intracranial atherosclerotic disease: periprocedural risks and short-term outcomes in a multicenter study. Stroke. 2011;42:107–11.

    Article  PubMed  Google Scholar 

  56. Wojak JC, Dunlap DC, Hargrave KR, DeAlvare LA, Culbertson HS, Connors JJ 3rd. Intracranial angioplasty and stenting: long-term results from a single center. AJNR Am J Neuroradiol. 2006;27:1882–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Park S, Lee DG, Chung WJ, Lee DH, Suh DC. Long-term outcomes of drug-eluting stents in symptomatic intracranial stenosis. Neurointervention. 2013;8:9–14.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Hussain MS, Fraser JF, Abruzzo T, et al. Standard of practice: endovascular treatment of intracranial atherosclerosis. J Neurointervent Surg. 2012;4:397–406.

    Article  Google Scholar 

  59. Mazighi M, Yadav JS, Abou-Chebl A. Durability of endovascular therapy for symptomatic intracranial atherosclerosis. Stroke. 2008;39:1766–9.

    Article  PubMed  Google Scholar 

  60. Fiorella D, Levy EI, Turk AS, et al. US multicenter experience with the wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results. Stroke. 2007;38:881–7.

    Article  PubMed  Google Scholar 

  61. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245.

    PubMed  Google Scholar 

  62. Karanam LSP, Sharma M, Alurkar A, Baddam SR, Pamidimukkala V, Polavarapu R. Balloon angioplasty for intracranial atherosclerotic disease: a multicenter study. J Vasc Interv Neurol. 2017;9:29–34.

    PubMed  PubMed Central  Google Scholar 

  63. Barnard ZR, Alexander MJ. Update in the treatment of intracranial atherosclerotic disease. Stroke Vasc Neurol. 2020;5:59–64.

    Article  PubMed  Google Scholar 

  64. Gruber P, Braun C, Kahles T, et al. Percutaneous transluminal angioplasty using the novel drug-coated balloon catheter SeQuent please NEO for the treatment of symptomatic intracranial severe stenosis: feasibility and safety study. J Neurointervent Surg. 2019;11:719–22.

    Article  Google Scholar 

  65. Han J, Zhang J, Zhang X, et al. Drug-coated balloons for the treatment of symptomatic intracranial atherosclerosis: initial experience and follow-up outcome. J Neurointervent Surg. 2019;11:569–73.

    Article  Google Scholar 

  66. Investigators SS. Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results. Stroke. 2004;35:1388–92.

    Article  Google Scholar 

  67. Bose A, Hartmann M, Henkes H, et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke. 2007;38:1531–7.

    Article  CAS  PubMed  Google Scholar 

  68. Alexander MJ, Zauner A, Chaloupka JC, et al. WEAVE trial: final results in 152 on-label patients. Stroke. 2019;50:889–94.

    Article  PubMed  Google Scholar 

  69. Roy P, Bonello L, Torguson R, et al. Temporal relation between Clopidogrel cessation and stent thrombosis after drug-eluting stent implantation. Am J Cardiol. 2009;103:801–5.

    Article  CAS  PubMed  Google Scholar 

  70. Yu SC, Leung TW, Lee KT, Hui JW, Wong LK. Angioplasty and stenting of atherosclerotic middle cerebral arteries with Wingspan: evaluation of clinical outcome, restenosis, and procedure outcome. AJNR Am J Neuroradiol. 2011;32:753–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Palmerini T, Biondi-Zoccai G, Della Riva D, et al. Stent thrombosis with drug-eluting stents: is the paradigm shifting? J Am Coll Cardiol. 2013;62:1915–21.

    Article  CAS  PubMed  Google Scholar 

  72. Kurre W, Berkefeld J, Brassel F, et al. In-hospital complication rates after stent treatment of 388 symptomatic intracranial stenoses: results from the INTRASTENT multicentric registry. Stroke. 2010;41:494–8.

    Article  PubMed  Google Scholar 

  73. Zaidat OO, Fitzsimmons BF, Woodward BK, et al. Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial. JAMA. 2015;313:1240–8.

    Article  CAS  PubMed  Google Scholar 

  74. Derdeyn CP, Fiorella D, Lynn MJ, et al. Mechanisms of stroke after intracranial angioplasty and stenting in the SAMMPRIS trial. Neurosurgery. 2013;72:777–95. discussion 795

    Article  PubMed  Google Scholar 

  75. Fiorella D, Derdeyn CP, Lynn MJ, et al. Detailed analysis of periprocedural strokes in patients undergoing intracranial stenting in Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS). Stroke. 2012;43:2682–8.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Ma N, Zhang Y, Shuai J, et al. Stenting for symptomatic intracranial arterial stenosis in China: 1-year outcome of a multicentre registry study. Stroke Vasc Neurol. 2018;3:176–84.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Wang ZL, Gao BL, Li TX, et al. Outcomes of middle cerebral artery angioplasty and stenting with Wingspan at a high-volume center. Neuroradiology. 2016;58:161–9.

    Article  PubMed  Google Scholar 

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Disclosures

Funding sources: None.

Conflict of Interest: None.

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Authors and Affiliations

  1. Department of Endovascular Neurosurgery, Mercy St. Vincent Medical Center, Toledo, OH, USA

    Saif Bushnaq, Nicholas Liaw & Osama O. Zaidat

  2. Department of Neurology, University of Toledo, Toledo, OH, USA

    Alicia C. Castonguay

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  1. Saif Bushnaq
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  2. Nicholas Liaw
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  3. Alicia C. Castonguay
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  4. Osama O. Zaidat
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Correspondence to Osama O. Zaidat .

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Editors and Affiliations

  1. Neurology and Psychiatry, Saint Louis University, Saint Louis, MO, USA

    Randall C. Edgell

  2. Department of Neurology, Saint Louis University, St. Louis, MO, USA

    Kara M. Christopher

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Bushnaq, S., Liaw, N., Castonguay, A.C., Zaidat, O.O. (2022). Endovascular Treatment of Intracranial Atherosclerosis. In: Edgell, R.C., M. Christopher, K. (eds) Neurointervention in the Medical Specialties. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-030-87428-5_5

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  • DOI: https://doi.org/10.1007/978-3-030-87428-5_5

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