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Neueste Studien zu intrakraniellen Stenosen

Recent studies on intracranial stenosis

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Zusammenfassung

Klinisches Problem

Symptomatische intrakranielle arterielle Gefäßstenosen sind mit einem hohen Schlaganfallrisiko behaftet. Durch Thrombozytenaggregationshemmer und Antikoagulation kommt es zu keiner wesentlichen Reduktion dieses Risikos. Alternative Methoden sind deshalb dringend erforderlich.

Neue Therapieverfahren

Das Konzept der perkutanen Therapie etwa mit Ballondilatation oder Stentimplantation erscheint auf den ersten Blick erfolgversprechend, weswegen Stents speziell für die Intervention an zerebralen Gefäßen entwickelt wurden.

Leistungsfähigkeit

Die interventionellen Techniken haben sich bereits frühzeitig in nichtrandomisierten Studien bewährt. In der einzigen randomisierten Studie war die Stentimplantation jedoch mit einem hohen perioperativen Risiko verbunden.

Bewertung und Empfehlung für die Praxis

Die bisherige Studienlage lässt bedingt durch Designdefizite keine definitiven Rückschlüsse hinsichtlich der Effektivität der perkutanen Intervention zur Behandlung symptomatischer intrakranieller Stenosen zu. Deshalb wäre es voreilig, diese Therapiemöglichkeit kategorisch abzulehnen.

Abstract

Clinical issue

Symptomatic intracranial stenoses are associated with a high risk of stroke. Medical management with platelet inhibitors or anticoagulation has not been shown to substantially lower this risk. Hence, alternative treatment options are desperately needed.

Treatment innovations

The concept of percutaneous intervention using balloon angioplasty with or without stenting is appealing at first sight which is why intracranial balloons and stents were developed.

Performance

Initial studies using dedicated intracranial stents were more promising; however, the only randomized trial recently published using a dedicated intracranial self-expanding stent demonstrated a high periprocedural complication rate.

Evaluation and practical recommendations

Due to study design limitations it would be premature to categorically denounce an interventional option for the treatment of symptomatic intracranial stenoses. More importantly, the results of the randomized SAMMPRIS trial should stimulate the development of safer technology and patient selection to minimize procedural risks. This will perhaps allow significant risk reduction of this potentially devastating intracranial condition when it cannot otherwise be addressed.

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Literatur

  1. Nahab F, Cotsonis G, Lynn M et al (2008) Prevalence and prognosis of coexistent asymptomatic intracranial stenosis. Stroke 39:1039–1041

    Article  PubMed  Google Scholar 

  2. Qureshi AI, Feldmann E, Gomez CR et al (2009) Intracranial atherosclerotic disease: an update. Ann Neurol 66:730–738

    Article  PubMed  CAS  Google Scholar 

  3. Kasner SE, Chimowitz MI, Lynn MJ et al (2006) Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 113:555–563

    Article  PubMed  Google Scholar 

  4. Kasner SE, Lynn MJ, Chimowitz MI et al (2006) Warfarin vs aspirin for symptomatic intracranial stenosis: subgroup analyses from WASID. Neurology 67:1275–1278

    Article  PubMed  CAS  Google Scholar 

  5. (o A) (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. The EC/IC Bypass Study Group. N Engl J Med 313:1191–1200

  6. Hatano T, Tsukahara T, Ogino E et al (2005) Stenting for vertebrobasilar artery stenosis. Acta Neurochir Suppl 94:137–141

    Article  PubMed  CAS  Google Scholar 

  7. Levy EI, Horowitz MB, Koebbe CJ et al (2001) Transluminal stent-assisted angioplasty of the intracranial vertebrobasilar system for medically refractory, posterior circulation ischemia: early results. Neurosurgery 48:1215–1221, discussion 21–23

    PubMed  CAS  Google Scholar 

  8. Eberhardt O, Naegele T, Raygrotzki S et al (2006) Stenting of vertebrobasilar arteries in symptomatic atherosclerotic disease and acute occlusion: case series and review of the literature. J Vasc Surg 43:1145–1154

    Article  PubMed  Google Scholar 

  9. Marks MP, Marcellus M, Norbash AM et al (1999) Outcome of angioplasty for atherosclerotic intracranial stenosis. Stroke 30:1065–1069

    Article  PubMed  CAS  Google Scholar 

  10. Marks MP, Marcellus ML, Do HM et al (2005) Intracranial angioplasty without stenting for symptomatic atherosclerotic stenosis: long-term follow-up. AJNR Am J Neuroradiol 26:525–530

    PubMed  Google Scholar 

  11. Marks MP, Wojak JC, Al-Ali F et al (2006) Angioplasty for symptomatic intracranial stenosis: clinical outcome. Stroke 37:1016–1020

    Article  PubMed  Google Scholar 

  12. Fiorella D, Chow MM, Anderson M et al (2007) A 7-year experience with balloon-mounted coronary stents for the treatment of symptomatic vertebrobasilar intracranial atheromatous disease. Neurosurgery 61:236–242, discussion 42–43

    Article  PubMed  Google Scholar 

  13. Chow MM, Masaryk TJ, Woo HH et al (2005) Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: midterm analysis of clinical and radiologic predictors of neurological morbidity and mortality. AJNR Am J Neuroradiol 26:869–874

    PubMed  Google Scholar 

  14. Engh JA, Levy EI, Howington JU, Guterman LR (2005) Intracranial angioplasty and stenting: modern approaches to revascularization for atherosclerotic disease. Neurosurg Clin N Am 16:297–308, ix

    Article  PubMed  Google Scholar 

  15. Gomez CR, Misra VK, Campbell MS, Soto RD (2000) Elective stenting of symptomatic middle cerebral artery stenosis. AJNR Am J Neuroradiol 21:971–973

    PubMed  CAS  Google Scholar 

  16. Levy EI, Howington JU, Engh JA et al (2005) Submaximal angioplasty and staged stenting for severe posterior circulation intracranial stenosis: a technique in evolution. Neurocrit Care 2:189–197

    Article  PubMed  Google Scholar 

  17. Yu W, Smith WS, Singh V et al (2005) Long-term outcome of endovascular stenting for symptomatic basilar artery stenosis. Neurology 64:1055–1057

    Article  PubMed  CAS  Google Scholar 

  18. SSYLVIA Study Investigators (2004) Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results. Stroke 35:1388–1392

    Article  Google Scholar 

  19. Bose A, Hartmann M, Henkes H et al (2007) A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 38:1531–1537

    Article  PubMed  CAS  Google Scholar 

  20. Zaidat OO, Klucznik R, Alexander MJ et al (2008) The NIH registry on the use of Wingspan stent for symptomatic 70–99% intracranial arterial stenosis. Neurology 70:1518–1524

    Article  PubMed  CAS  Google Scholar 

  21. Fiorella D Turk AS, Levy EI, et al (2011) US Wingspan Registry results: 12 months follow-up. Stroke 42:1976–1981

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  23. Henkes H, Bäzner H, Nelson PK (2011) Comment on: stenting versus aggressive medical therapy for intracranial arterial stenosis. Clin Neuroradiol 21(4):257–259

    Article  PubMed  CAS  Google Scholar 

  24. Vajda Z, Schmid E, Guthe T (2012) The modified Bose method for the endovascular treatment of intracranial atherosclerotic arterial stenoses using the Enterprise stent. Neurosurgery 70:91–101

    Article  PubMed  Google Scholar 

  25. Mori T, Fukuoka M, Kazita K, Mori K (1998) Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty. AJNR Am J Neuroradiol 19:1525–1533

    PubMed  CAS  Google Scholar 

  26. Kühn AL, Grunwald IQ (2012) SAMMPRIS – a look behind the scenes. Radiologe 52(2):105–106

    Article  PubMed  Google Scholar 

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Interessenkonflikt

Die korrespondierende Autorin gibt für sich und ihren Koautor an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. NIHR Oxford Biomedical Research Centre, Acute Vascular Imaging Centre , Oxford University Hospitals NHS Trust, Oxford, UK

    I.Q. Grunwald

  2. Veterans Affairs Medical Center, Minneapolis, MN, USA

    S.C. Bertog

Authors
  1. I.Q. Grunwald
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  2. S.C. Bertog
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Correspondence to I.Q. Grunwald.

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Grunwald, I., Bertog, S. Neueste Studien zu intrakraniellen Stenosen. Radiologe 52, 1107–1111 (2012). https://doi.org/10.1007/s00117-012-2371-7

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  • DOI: https://doi.org/10.1007/s00117-012-2371-7

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