Advertisement

Neuroradiology

, Volume 61, Issue 1, pp 97–102 | Cite as

Submaximal primary angioplasty for symptomatic intracranial atherosclerosis: peri-procedural complications and long-term outcomes

  • Guangge Peng
  • Jingyu Zhang
  • Baixue Jia
  • Ziqi Xu
  • Dapeng Mo
  • Ning Ma
  • Feng Gao
  • Zhongrong MiaoEmail author
Interventional Neuroradiology
  • 79 Downloads

Abstract

Purpose

The aim of our study is to report the peri-procedural complications and long-term stroke recurrent rate of symptomatic intracranial atherosclerosis (ICAS) patients who underwent submaximal primary angioplasty.

Methods

This is a retrospective analysis of consecutive patients in a single center who underwent submaximal primary angioplasty between January 1, 2012 and December 31, 2015. The peri-procedural complications and long-term outcomes are reported.

Results

Primary angioplasty was successfully performed in 129 patients (97.0%). The mean degree of pre-procedural stenosis was 81.9 ± 10.2%, and the degree of residual stenosis was 40.7 ± 19.1%. There were nine (6.8%) peri-procedural complications within 30 days, including seven ischemic strokes, one subarachnoid hemorrhage, and one asymptomatic intracerebral hemorrhage. None of them resulted in death. One-year follow-up was available in 122 patients (91.7%). Three more ischemic strokes (2.3%) which were in the territory of the treated artery occurred between 30 days and 1 year. The 1-year stroke and death rate was 9.0%, including peri-procedural stroke. Kaplan-Meier analysis showed a 3-year stroke-free survival of 87.2%.

Conclusion

Submaximal primary angioplasty can be performed with a low peri-procedural complication rate and relatively good clinical outcome at long-term follow-up for symptomatic ICAS patients.

Keywords

Atherosclerosis Angioplasty Intervention Stroke 

Notes

Compliance with ethical standards

Funding

This work was funded by Beijing High-Level Personnel Funds (Grant no. 2013-2-19) to ZM and the National Natural Science Foundation of China (Grant no. 81371290) to ZM.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Alaraj A, Wallace A, Dashti R, Patel P, Aletich V (2014) Balloons in endovascular neurosurgery: history and current applications. Neurosurgery 74(Suppl 1):S163–S190.  https://doi.org/10.1227/NEU.0000000000000220 CrossRefGoogle Scholar
  2. 2.
    Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR et al (2005) Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352(13):1305–1316.  https://doi.org/10.1056/NEJMoa043033 CrossRefGoogle Scholar
  3. 3.
    Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF et al (2011) Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365(11):993–1003.  https://doi.org/10.1056/NEJMoa1105335 CrossRefGoogle Scholar
  4. 4.
    Derdeyn CP, Chimowitz MI, Lynn MJ, Fiorella D, Turan TN, Janis LS 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.  https://doi.org/10.1016/s0140-6736(13)62038-3 CrossRefGoogle Scholar
  5. 5.
    Dumont TM, Kan P, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI (2012) Revisiting angioplasty without stenting for symptomatic intracranial atherosclerotic stenosis after the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS) study. Neurosurgery 71(6):1103–1110.  https://doi.org/10.1227/NEU.0b013e318271bcb8 CrossRefGoogle Scholar
  6. 6.
    Dumont TM, Sonig A, Mokin M, Eller JL, Sorkin GC, Snyder KV et al (2016) Submaximal angioplasty for symptomatic intracranial atherosclerosis: a prospective phase I study. J Neurosurg 125(4):964–971.  https://doi.org/10.3171/2015.8.JNS15791 CrossRefGoogle Scholar
  7. 7.
    Fiorella D, Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B et al (2007) US multicenter experience with the wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results. Stroke 38(3):881–887.  https://doi.org/10.1161/01.STR.0000257963.65728.e8 CrossRefGoogle Scholar
  8. 8.
    Fiorella D, Derdeyn CP, Lynn MJ, Barnwell SL, Hoh BL, Levy EI 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.  https://doi.org/10.1161/STROKEAHA.112.661173 CrossRefGoogle Scholar
  9. 9.
    Lau AY, Wong EH, Wong A, Mok VC, Leung TW, Wong KS (2012) Significance of good collateral compensation in symptomatic intracranial atherosclerosis. Cerebrovasc Dis 33(6):517–524.  https://doi.org/10.1159/000337332 CrossRefGoogle Scholar
  10. 10.
    Leng X, Wong KS, Liebeskind DS (2014) Evaluating intracranial atherosclerosis rather than intracranial stenosis. Stroke 45(2):645–651.  https://doi.org/10.1161/STROKEAHA.113.002491 CrossRefGoogle Scholar
  11. 11.
    Liebeskind DS, Cotsonis GA, Saver JL, Lynn MJ, Turan TN, Cloft HJ et al (2011) Warfarin-aspirin symptomatic intracranial disease I. Collaterals dramatically alter stroke risk in intracranial atherosclerosis. Ann Neurol 69(6):963–974.  https://doi.org/10.1002/ana.22354 CrossRefGoogle Scholar
  12. 12.
    Marks MP, Wojak JC, Al-Ali F, Jayaraman M, Marcellus ML, Connors JJ et al (2006) Angioplasty for symptomatic intracranial stenosis: clinical outcome. Stroke 37(4):1016–1020.  https://doi.org/10.1161/01.STR.0000206142.03677.c2 CrossRefGoogle Scholar
  13. 13.
    Miao Z, Wang B, Feng L, Hua Y, Ling F (2011) Primary angioplasty for a subtype of symptomatic middle cerebral artery stenosis. Neuroradiology 53(9):651–657.  https://doi.org/10.1007/s00234-010-0778-2 CrossRefGoogle Scholar
  14. 14.
    Nguyen TN, Zaidat OO, Gupta R, Nogueira RG, Tariq N, Kalia JS et al (2011) Balloon angioplasty for intracranial atherosclerotic disease: periprocedural risks and short-term outcomes in a multicenter study. Stroke 42(1):107–111.  https://doi.org/10.1161/STROKEAHA.110.583245 CrossRefGoogle Scholar
  15. 15.
    Okada H, Terada T, Tanaka Y, Tomura N, Kono K, Yoshimura R et al (2015) Reappraisal of primary balloon angioplasty without stenting for patients with symptomatic middle cerebral artery stenosis. Neurol Med Chir 55(2):133–140.  https://doi.org/10.2176/nmc.oa.2014-0156 CrossRefGoogle Scholar
  16. 16.
    Qureshi AI, Caplan LR (2014) Intracranial atherosclerosis. Lancet 383(9921):984–998.  https://doi.org/10.1016/s0140-6736(13)61088-0 CrossRefGoogle Scholar
  17. 17.
    Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI (2000) A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 21(4):643–646Google Scholar
  18. 18.
    Sangha RS, Naidech AM, Corado C, Ansari SA, Prabhakaran S (2017) Challenges in the medical management of symptomatic intracranial stenosis in an urban setting. Stroke 48(8):2158–2163.  https://doi.org/10.1161/strokeaha.116.016254 CrossRefGoogle Scholar
  19. 19.
    Villwock MR, Padalino DJ, Ramaswamy R, Deshaies EM (2016) Primary angioplasty versus stenting for endovascular management of intracranial atherosclerotic disease following acute ischemic stroke. J Vasc Interv Neurol 9(1):1–6Google Scholar
  20. 20.
    Zaidat OO, Klucznik R, Alexander MJ, Chaloupka J, Lutsep H, Barnwell S et al (2008) The NIH registry on use of the wingspan stent for symptomatic70-99% intracranial arterial stenosis. Neurology 70(17):1518–1524.  https://doi.org/10.1212/01.wnl.0000306308.08229.a3 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Guangge Peng
    • 1
    • 2
  • Jingyu Zhang
    • 1
    • 2
  • Baixue Jia
    • 1
    • 2
  • Ziqi Xu
    • 3
  • Dapeng Mo
    • 1
    • 2
  • Ning Ma
    • 1
    • 2
  • Feng Gao
    • 1
    • 2
  • Zhongrong Miao
    • 1
    • 2
    Email author
  1. 1.Department of Interventional Neuroradiology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
  2. 2.National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseasesBeijing Institute for Brain DisordersBeijingChina
  3. 3.The First Affiliated Hospital of Zhejiang UniversityHangzhouChina

Personalised recommendations