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Solving the Issue of Restenosis After Stenting of Intracranial Stenoses: Experience with Two Thin-Strut Drug-Eluting Stents (DES)—Taxus Element™ and Resolute Integrity™

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Abstract

Purpose

Thin-strut, flexible DES are suitable for intracranial stenting and may improve long-term vessel patency. The purpose of this study was to report our experience with two new-generation DES for the treatment of intracranial atherosclerotic disease.

Patients and Methods

We retrospectively reviewed all patients treated with Taxus Element™ or Resolute Integrity™ stent for an intracranial atherosclerotic stenosis between March 2011 and August 2013. Technical success was defined as the ability to deploy the device at the desired location and reduce the degree of stenosis below 50 %. All procedure-related strokes were recorded. Control angiography was scheduled after 6 weeks, 3, 6, and 12 months and yearly thereafter. A luminal narrowing ≥50 % was regarded as a restenosis. Stroke recurrence in the territory of the treated artery was reported.

Results

In the defined period we treated 101 patients harboring 117 intracranial stenoses. The procedure was successful in 100 (85.5 %) lesions. Procedure-related strokes occurred in 10 (9.9 %) patients with a permanent morbidity in 3 (3.0 %). Follow-up angiography was available for 83 of 100 (83.0 %) successfully treated lesions with an average of 355 days (IQR 153–482 days). Three (3.6 %) asymptomatic restenoses were detected. All occurred after treatment with Resolute Integrity™, none after Taxus Element™ (p = 0.059). New strokes in the territory of the treated artery were encountered in 2 (2.6 %) occasions.

Conclusion

Thin-strut DES improve long-term patency and reduce the risk of subsequent stroke. Differences between devices may exist. Feasibility is comparable to bare-metal balloon-mounted stents and procedure-related strokes occurred within the expected range.

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References

  1. Chimowitz M, Lynn M, Derdeyn C et al (2011) Stenting versus medical therapy for intracranial arterial stenosis. N Engl J Med 365(11):993–1003

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Derdeyn CP, Chimowitz MI, Lynn MJ et al (2014) Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet 383(9914):333–341

    Article  PubMed Central  PubMed  Google Scholar 

  3. Zaidat OO, Castonguay AC, Nguyen TN et al (2014) 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 6(3):225–230

    Article  Google Scholar 

  4. Levy E, Turk A, Albuquerque F et al (2007) Wingspan in-stent restenosis and thrombosis. Incidence, clinical presentation, and management. Neurosurgery 61(3):644–651

    Article  PubMed  Google Scholar 

  5. Vajda Z, Schmid E, Güthe T et al (2012) The modified Bose method for the endovascular treatment of intracranial atherosclerotic arterial stenoses using the Enterprise stent. Neurosurgery 70(1):91–101

    Article  PubMed  Google Scholar 

  6. Jiang WJ, Cheng-Ching E, Abou-Chebl A et al (2012) Multicenter Analysis of stenting in symptomatic intracranial atherosclerosis. Neurosurgery 70(1):25–31

    Article  PubMed  Google Scholar 

  7. Jin M, Fu X, Wei Y et al (2013) Higher risk of recurrent ischemic events in patients with intracranial in-stent-restenosis. Stroke 44(11):2990–2994

    Article  PubMed  Google Scholar 

  8. Bangalore S, Kumar S, Fusaro M et al (2012) Short- and long-term outcomes with drug-eluting and bare-metal coronary stents. A mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation 125(23):2873–2891

    Article  CAS  PubMed  Google Scholar 

  9. Brilakis E, Patel V, Banerjee S (2013) Medical management after coronary stent implantation: a review. JAMA 310(2):189–198

    Article  CAS  PubMed  Google Scholar 

  10. Dewilde W, Oirbans T, Verheugt F et al (2013) Use of clopidogrel with or without aspirin in patients taking anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomized, controlled trial. Lancet 381(9872):1107–1115

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Schoenfeldt P, Krützelmann A, Bußmeyer M (2014) Elective treatment of intracranial stenosis with the balloon-expandable Pharos Vitesse stent: 30-day stroke rate and complications. J Neurointervent Surg. doi:10.1136/neurointersurg-2013-011019

    Google Scholar 

  13. Suh D, Kim J, Choi J et al (2008) Intracranial stenting of severe symptomatic intracranial stenosis: results of 100 consecutive patients. Am J Neuroradiol 29(4):781–785

    Article  CAS  PubMed  Google Scholar 

  14. Fiorella D, Chow M, 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(2):236–243

    Article  PubMed  Google Scholar 

  15. Kurre W, Brassel F, Brüning J et al (2012) Complication rates using balloon expandable and self-expanding stents for the treatment of intracranial atherosclerotic stenoses: analysis of the INTRASTENT multicentric registry. Neuroradiology 54(1):43–50

    Article  PubMed  Google Scholar 

  16. Fiorella D, Derdeyn C, Lynn M et al (2012) 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 43(10):2682–2688

    Article  PubMed Central  PubMed  Google Scholar 

  17. Kurre W, Berkefeld J, Brassel F et al (2010) In-Hospital complication rates after stent treatment of 388 symptomatic intracranial stenoses—results from the INTRASTENT multicentric registry. Stroke 41(3):494–498

    Article  PubMed  Google Scholar 

  18. Derdeyn C, Fiorella D, Lynn M et al (2013) Mechanisms of stroke after intracranial angioplasty and stenting in the SAMMPRIS trial. Neurosurgery 72(5):777–795

    Article  PubMed Central  PubMed  Google Scholar 

  19. Riedel C, Tietke M, Alfke K et al (2009) Subacute stent thrombosis in intracranial stenting. Stroke 40(4):1310–1340

    Article  PubMed  Google Scholar 

  20. Daneshi A, Hadizadeh H, Mahmoudian S et al (2004) Pulsatile tinnitus and carotid artery atherosclerosis. Int Tinnitus J 10(2):161–164

    PubMed  Google Scholar 

  21. Ihn Y, Jung W, Kim B (2013) Disappeared pulsatile tinnitus related to petrous segment stenosis of the ICA after relief of the stenosis by stenting. Intervent Neuroradiol 19(1):97–101

    CAS  Google Scholar 

  22. Kirkby-Bott J, Gibbs HH (2004) Carotid endarterectomy relieves pulsatile tinnitus associated with severe ipsilateral carotid stenosis. Eur J Vasc Endovasc Surg 27(6):651–653

    Article  CAS  PubMed  Google Scholar 

  23. Kakkos S, Nicolaides A, Charalabmous I et al (2014) Predictors and clinical significance of preogression or regression of asymptomatic carotid stenosis. J Vasc Surg 59(4):956–967

    Article  PubMed  Google Scholar 

  24. Balestrini S, Lupidi F, Balucani C et al (2013) One-year progression of moderate asymptomatic carotid stenosis predicts the risk of vascular events. Stroke 44(3):792–794

    Article  PubMed  Google Scholar 

  25. Kern R, Steinke W, Daffertshofer M et al (2005) Stroke recurrences in patients with symptomatic vs asymptomatic middle cerebral artery disease. Neurology 65(6):859–864

    Article  CAS  PubMed  Google Scholar 

  26. Nahab F, Cotsonis G, Lynn M et al (2008) Prevalence and prognosis of coexistent asymptomatic intracranial stenosis. Stroke 39(3):1039–1041

    Article  PubMed Central  PubMed  Google Scholar 

  27. Mercado-Gómez O, Ferrera P, Arias C (2004) Histopathologic changes induced by the microtubule-stabilizing agent Taxol in the rat hippocampus in vivo. J Neurosci Res 78:553–562

    Article  PubMed  Google Scholar 

  28. Figueroa-Masot X, Hetman M, Higgins M et al (2001) Taxol induces apoptosis in cortical neurons by a mechanism independent of Bcl-2 phosphorylation. J Neurosci 21(13):4657–4667

    CAS  PubMed  Google Scholar 

  29. Sengottuvel V, Fischer D (2011) Facilitating axon regeneration in the injured CNS by microtubules stabilization. Commun Integr Biol 4(4):391–393

    Article  PubMed Central  PubMed  Google Scholar 

  30. Quin W, Tan C, Huang X et al (2011) Repamycin-induced posterior reversible encephalopathy in a kidney transplantation patient. Int Urol Nephrol 43(3):913–916

    Article  Google Scholar 

  31. Bodkin C, Eidelman B (2007) Sirolimus-induced posterior reversible encelopathy. Neurology 68(23):2039–2040

    Article  PubMed  Google Scholar 

  32. Moskowitz A, Nolan C, Lis E et al (2007) Posterior reversible encephalopathy syndrome due to sirolimus. Bone Marrow Transplant 39(10):653–654

    Article  CAS  PubMed  Google Scholar 

  33. Levy E, Hanel R, Tio F et al (2006) Safety and pharmacokinetics of sirolimus-eluting stents in the canine cerebral vasculature: 180 day assessment. Neurosurgery 59:925–934

    Article  PubMed  Google Scholar 

  34. Abou-Chebl A, Bashir Q, Yadav Y (2005) Drug-eluting stents for the treatment of intracranial atherosclerosis initial experience and midterm angiographic follow-up. Stroke 36(12):e16–e165

    Article  Google Scholar 

  35. Gupta R, Al-Ali F, Thomas A et al (2006) Safety, feasibility, and short-term follow-up of drug-eluting stent placement in the intracranial and extracranial circulation. Stroke 37(10):2562–2566

    Article  CAS  PubMed  Google Scholar 

  36. Qureshi A, Kirmani J, Hussein H et al (2006) Early and intermediate-term outcomes with drug-eluting stents in high-risk patients with symptomatic intracranial stenosis. Neurosurgery 59(5):1044–1051

    PubMed  Google Scholar 

  37. Steinfort B, Ng P, Faulder K et al (2007) Midterm outcomes of paclitaxel-eluting stents for the treatment of intracranial posterior circulation stenoses. J Neurosurg 106(2):222–225

    Article  CAS  PubMed  Google Scholar 

  38. Song L, Li J, Gu Y et al (2012) Drug-eluting vs. bare-metal stents for symptomatic vertebral artery Stenosis. J Endovasc Ther 19(2):231–238

    Article  PubMed  Google Scholar 

  39. Lu H, Zheng P, Zhang W (2013) Long-term outcome of drug-eluting stenting for stenoses of the intracranial vertebrobasilar artery and vertebral ostium. J Neurointervent Surg 5(5):435–439

    Article  Google Scholar 

  40. Lee J, Jo S, Jo K et al (2013) Comparison of drug-eluting coronary stents, bare coronary stents and self-expanding stents in angioplasty of middle cerebral artery stenoses. J Cerebrovasc Endovasc Neurosurg 15(2):85–95

    Article  PubMed Central  PubMed  Google Scholar 

  41. Park S, Lee D, Chung W et al (2013) Long-term outcomes of drug-eluting stents in symptomatic intracranial stenosis. Neurointervention 8(1):9–14

    Article  PubMed Central  PubMed  Google Scholar 

  42. Vajda Z, Aguilar M, Göhringer T et al (2012) Treatment of intracranial atherosclerotic disease with a balloon-expandable paclitaxel eluting stent. Clin Neuroradiol 22(3):227–233

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  43. Vajda Z, Güthe T, Aguilar M et al (2013) Prevention of intracranial in-stent restenoses: predilatation with a drug eluting balloon, followed by the deployment of a self-expanding stent. Cardiovasc Intervent Radiol 36(2):346–352

    Article  PubMed Central  PubMed  Google Scholar 

  44. Psychogios M, Schramm P, Buhk J et al (2010) Angiographic CT after intravenous contrast agent application: a noninvasive follow-up tool after intracranial angioplasty and stenting. Am J Neuroradiol 31:1886–1891

    Article  PubMed  Google Scholar 

  45. Struffert T, Kloska S, Engelhorn T et al (2011) Opitimized intravenous flat detector CT for non-invasive visualization of stents: first results. Eur Radiol 21(2):411–418

    Article  PubMed  Google Scholar 

  46. Lagerquvist B, Stenestrand U, Lindback J (2007) Long-term outcomes with drug-eluting stents versus bare metal stents in Sweden. N Engl J Med 356(10):1009–1019

    Article  Google Scholar 

  47. Daemen J, Wenaweser P, Tsuchida K (2007) Early and late coronary stent thrombosis of sirolimus eluting and paclitaxel eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 369(9562):667–678

    Article  CAS  PubMed  Google Scholar 

  48. Samuels O, Joseph G, Lynn M et al (2000) A standardized method for measuring intracranial arterial stenosis. Am J Neuroradiol 21:643–646

    CAS  PubMed  Google Scholar 

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Acknowledgments

We thank James Lago for language review, Ralf Hannes for assistance with the image material, and Hiltrud Niggemann for statistical support.

Conflict of interest

Wiebke Kurre is a consultant to phenox, received speaker’s honoraria from Codman Inc., travel expenses from phenox and a research Grant from Covidien. Marta Aguilar-Pérez has proctoring contracts with phenox and a consulting agreement with Codman Inc. Sebastian Fischer has no conflict of interest. Guy Arnold received speaker’s honoraria and travel expenses from Allergan Pharma, Boehringer Ingelheim, EISAI, Genzyme, Merck-Serono, Novartis, UCB, TEVA. Elisabeth Schmid received speaker’s honoraria from Bayer Vital and Bristol-Meyers-Squibb. Hansjörg Bäzner received speaker’s honoraria from Biogen Idec, Bayer Vital, UCB Pharma and Boehringer Ingelheim. Hans Henkes has proctoring and/or consulting agreements with Covidien, Codman, ab medica, MicroVention, phenox and SHS Tübingen, is co-founder and shareholder of phenox and received scientific Grants from Siemens, Covidien and Codman. Informed consent was obtained from all individual patients included in this case series. For a retrospective data analysis formal ethics approval was not required. The ethics committee was consulted and confirmed exemption.

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Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany

    Wiebke Kurre, Marta Aguilar-Pérez & Hans Henkes

  2. Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, In der Schornau 23-25, 44892, Bochum, Germany

    Sebastian Fischer

  3. Klinik für Neurologie, Klinikverbund Südwest, Klinikum Sindelfingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Germany

    Guy Arnold

  4. Klinik für Neurologie, Klinikum Stuttgart, Tunzhofer Strasse 14-16, 70191, Stuttgart, Germany

    Elisabeth Schmid & Hansjörg Bäzner

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  1. Wiebke Kurre
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Correspondence to Wiebke Kurre.

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Kurre, W., Aguilar-Pérez, M., Fischer, S. et al. Solving the Issue of Restenosis After Stenting of Intracranial Stenoses: Experience with Two Thin-Strut Drug-Eluting Stents (DES)—Taxus Element™ and Resolute Integrity™. Cardiovasc Intervent Radiol 38, 583–591 (2015). https://doi.org/10.1007/s00270-014-1001-3

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