Journal of Neurology

, Volume 257, Issue 11, pp 1899–1908

Stenting for the treatment of high-grade intracranial stenoses

  • S. Lanfranconi
  • A. Bersano
  • V. Branca
  • E. Ballabio
  • M. Isalberti
  • R. Papa
  • L. Candelise
Original Communication

Abstract

To date, evidence to recommend endovascular treatment in patients with intracranial stenoses is lacking. Recently, the introduction of self-expanding stents (Wingspan Stent System) aroused considerable expectations in their employ for stroke prevention. We report a single-center experience of percutaneous transluminal angioplasty and stenting in a series of consecutive patients with intracranial stenoses and compare the safety and performance of balloon-mounted stents versus self-expanding stent systems (Wingspan). Thirty-four patients with 39 severe (>70%) intracranial stenoses were treated during a 6-year period. An independent stroke neurologist collected data about intra and periprocedural complications and short-term outcome. We considered as endpoint measures (1) any 30-day stroke or death (2) any major 30-day complication and (3) procedure technical success. Technical success was achieved in all patients. No vessel dissection or ruptures were observed. The 30-day stroke/death rate was 17.9%. Five ischemic strokes in the territory of treated vessels and two intracranial hemorrhages occurred respectively within 24 h and 5 days after endovascular treatment. Three (17.6%) patients of Wingspan treated group and four (18.2%) of the patients treated with different stent systems had unfavorable outcome. Our study confirms that endovascular treatment can be performed with a high technical success rate, even though the safety of these devices has still to be demonstrated.

Keywords

Intracranial stenosis Stroke Secondary prevention Stents Angioplasty 

References

  1. 1.
    Sacco RL, Kargman DE, Gu Q, Zamanillo MC (1995) Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 6(1):14–20Google Scholar
  2. 2.
    Thijs VN, Albers GW (2000) Symptomatic intracranial atherosclerosis: outcome of patients who fail antithrombotic therapy. Neurology 55(4):490–497PubMedGoogle Scholar
  3. 3.
    Qureshi AI, Ziai WC, Yahia AM, Mohammad Y, Sen S, Agarwal P, Zaidat OO, Suarez JI, Wityk RJ (2003) Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: a multicenter study. Neurosurgery 52(5):1033–1039CrossRefPubMedGoogle Scholar
  4. 4.
    SSYLVIA Study Investigators (2004) Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA): study results. Stroke 35(6):1388–1392CrossRefGoogle Scholar
  5. 5.
    Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, Levine SR, Chaturvedi S, Kasner SE, Benesch CG, Sila CA, Jovin TG, Romano JG, Warfarin-Aspirin Symptomatic Intracranial Disease Trial Investigators (2005) Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352(13):1305–1316CrossRefPubMedGoogle Scholar
  6. 6.
    Kasner SE, Lynn MJ, Chimowitz MI, Frankel MR, Howlett-Smith H, Hertzberg VS, Chaturvedi S, Levine SR, Stern BJ, Benesch CG, Jovin TG, Sila CA, Romano JG, Warfarin Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators (2006) Warfarin vs aspirin for symptomatic intracranial stenosis: subgroup analyses from WASID. Neurology 67(7):1275–1278CrossRefPubMedGoogle Scholar
  7. 7.
    Koroshetz WJ (2005) Warfarin, aspirin, and intracranial vascular disease. N Engl J Med 352(13):1368–1370CrossRefPubMedGoogle Scholar
  8. 8.
    Hartmann M, Jansen O (2005) Angioplasty and stenting of intracranial stenosis. Curr Opin Neurol 18(1):39–45CrossRefPubMedGoogle Scholar
  9. 9.
    Mori T, Kazita K, Chokyu K, Mima T, Mori K (2000) Short-term arteriographic and clinical outcome after cerebral angioplasty and stenting for intracranial vertebrobasilar and carotid atherosclerotic occlusive disease AJNR. Am J Neuroradiol 21(2):249–254PubMedGoogle Scholar
  10. 10.
    Hauth EA, Gissler HM, Drescher R, Jansen C, Jaeger HJ, Mathias KD (2004) Angioplasty or stenting of extra- and intracranial vertebral artery stenoses. Cardiovasc Interv Radiol 27(1):51–57CrossRefGoogle Scholar
  11. 11.
    Straube T, Stingele R, Jansen O (2005) Primary stenting of intracranial atherosclerotic stenoses. Cardiovasc Interv Radiol 28(3):289–295CrossRefGoogle Scholar
  12. 12.
    Qureshi AI, Kirmani JF, Hussein HM, Harris-Lane P, Divani AA, Suri MF, Janjua N, Alkawi A (2006) Early and intermediate-term outcomes with drug-eluting stents in high-risk patients with symptomatic intracranial stenosis. Neurosurgery 59(5):1044–11451PubMedGoogle Scholar
  13. 13.
    Gupta R, Al-Ali F, Thomas AJ, Horowitz MB, Barrow T, Vora NA, Uchino K, Hammer MD, Wechsler LR, Jovin TG (2006) Safety, feasibility, and short-term follow-up of drug-eluting stent placement in the intracranial and extracranial circulation. Stroke 37(10):2562–2566CrossRefPubMedGoogle Scholar
  14. 14.
    Lee CY, Yim MB (2006) Primary stent therapy for symptomatic intracranial atherosclerotic stenosis: 1-year follow-up angiographic and midterm clinical outcomes. J Neurosurg 105(2):235–241CrossRefGoogle Scholar
  15. 15.
    Jiang WJ, Srivastava T, Gao F, Du B, Dong KH, Xu XT (2006) Perforator stroke after elective stenting of symptomatic intracranial stenosis. Neurology 66(12):1868–1872CrossRefPubMedGoogle Scholar
  16. 16.
    Jiang WJ, Du B, Leung TW, Xu XT, Jin M, Dong KH (2007) Symptomatic intracranial stenosis: cerebrovascular complications from elective stent placement. Radiology 243(1):188–197CrossRefPubMedGoogle Scholar
  17. 17.
    Suh DC, Kim JK, Choi JW, Choi BS, Pyun HW, Choi YJ, Kim MH, Yang HR, Ha HI, Kim SJ, Lee DH, Choi CG, Hahm KD, Kim JS (2008) Intracranial stenting of severe symptomatic intracranial stenosis: results of 100 consecutive patients. AJNR Am J Neuroradiol 29(4):781–785CrossRefPubMedGoogle Scholar
  18. 18.
    Henkes H, Miloslavski E, Lowens S, Reinartz J, Liebig T, Kühne D (2005) Treatment of intracranial atherosclerotic stenoses with balloon dilatation and self-expanding stent deployment (WingSpan). Neuroradiology 47(3):222–228CrossRefPubMedGoogle Scholar
  19. 19.
    Fiorella D, Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, Hanel RA, Woo H, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG (2007) US multicenter experience with the wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results. Stroke 38(3):881–887CrossRefPubMedGoogle Scholar
  20. 20.
    Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, Pride L, Purdy P, Welch B, Woo H, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella DJ (2007) Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management. Neurosurgery 61(3):644–650CrossRefPubMedGoogle Scholar
  21. 21.
    Bose A, Hartmann M, Henkes H, Liu HM, Teng MM, Szikora I, Berlis A, Reul J, Yu SC, Forsting M, Lui M, Lim W, Sit SP (2007) A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 38(5):1517–1531CrossRefGoogle Scholar
  22. 22.
    Zaidat OO, Klucznik R, Alexander MJ, Chaloupka J, Lutsep H, Barnwell S, Mawad M, Lane B, Lynn MJ, Chimowitz M, NIH Multi-center Wingspan Intracranial Stent Registry Study Group (2008) The NIH registry on use of the Wingspan stent for symptomatic 70–99% intracranial arterial stenosis. Neurology 70(17):1518–1524CrossRefPubMedGoogle Scholar
  23. 23.
    Gröschel K, Schnaudigel S, Pilgram SM, Wasser K, Kastrup A (2009) A systematic review on outcome after stenting for intracranial atherosclerosis. Stroke 40(5):e340–e347CrossRefPubMedGoogle Scholar
  24. 24.
    Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20(7):864–870PubMedGoogle Scholar
  25. 25.
    Rankin J (1957) Cerebral vascular accidents in patients over the age of 60. II Prognosis. Scott Med J 2:200–215PubMedGoogle Scholar
  26. 26.
    Candelise L, Pinardi G, Aritzu E et al (1994) Telephone interview for stroke outcome assessment. Cerebrovasc Dis 4:341–343CrossRefGoogle Scholar
  27. 27.
    Hatano S (1976) Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 54:541–553PubMedGoogle Scholar
  28. 28.
    The EC/IC Bypass Study Group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313:1191–1200CrossRefGoogle Scholar
  29. 29.
    Cruz-Flores S, Diamond AL (2006) Angioplasty for intracranial artery stenosis. Cochrane Database Syst Rev 3:CD004133PubMedGoogle Scholar
  30. 30.
    Nahab F, Lynn MJ, Kasner SE, Alexander MJ, Klucznik R, Zaidat OO, Chaloupka J, Lutsep H, Barnwell S, Mawad M, Lane B, Chimowitz MI, NIH Multicenter Wingspan Intracranial Stent Registry Study Group (2009) Risk factors associated with major cerebrovascular complications after intracranial stenting. Neurology 72(23):2014–2019CrossRefPubMedGoogle Scholar
  31. 31.
    Gupta R, Schumacher HC, Mangla S, Meyers PM, Duong H, Khandji AG, Marshall RS, Mohr JP, Pile-Spellman J (2003) Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis. Neurology 61(12):1729–1735PubMedGoogle Scholar
  32. 32.
    Stenting vs. Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial [NCT00576693]. http://www.clinicaltrials.gov. Accessed 23 Mar 2010
  33. 33.
    Turan TN, Maidan L, Cotsonis G, Lynn MJ, Romano JG, Levine SR, Chimowitz MI, Warfarin-Aspirin Symptomatic Intracranial Disease Investigators (2009) Failure of antithrombotic therapy and risk of stroke in patients with symptomatic intracranial stenosis. Stroke 40(2):505–509CrossRefPubMedGoogle Scholar
  34. 34.
    Marzewski DJ, Furlan AJ, St Louis P, Little JR, Modic MT, Williams G (1982) Intracranial internal carotid artery stenosis: long-term prognosis. Stroke 13(6):821–824PubMedGoogle Scholar
  35. 35.
    Wholey MH, Al-Mubarek N, Wholey MH (2003) Updated review of the Global Carotid Artery Stent Registry. Catheter Cardiovasc Interv 60:259–266CrossRefPubMedGoogle Scholar
  36. 36.
    Abou-Chebl A, Krieger DW, Bajzer CT, Yadav JS (2006) Intracranial angioplasty and stenting in the awake patient. J Neuroimaging 16(3):216–223CrossRefPubMedGoogle Scholar
  37. 37.
    Jiang WJ, Xu XT, Du B, Dong KH, Jin M, Wang QH, Ma N (2007) Comparison of elective stenting of severe vs moderate intracranial atherosclerotic stenosis. Neurology 68(6):420–426CrossRefPubMedGoogle Scholar
  38. 38.
    Abruzzo TA, Tong FC, Waldrop AS, Workman MJ, Cloft HJ, Dion JE (2007) Basilar artery stent angioplasty for symptomatic intracranial athero-occlusive disease: complications and late midterm clinical outcomes. AJNR Am J Neuroradiol 28(5):808–815PubMedGoogle Scholar
  39. 39.
    Freitas JM, Zenteno M, Aburto-Murrieta Y, Koppe G, Abath C, Nunes JA, Raupp E, Hidalgo R, Pieruccetti MA, Lee A (2007) Intracranial arterial stenting for symptomatic stenoses: a Latin American experience. Surg Neurol 68(4):378–386CrossRefPubMedGoogle Scholar
  40. 40.
    Steinfort B, Ng PP, Faulder K, Harrington T, Grinnell V, Sorby W, Morgan MK (2007) Midterm outcomes of paclitaxel-eluting stents for the treatment of intracranial posterior circulation stenoses. J Neurosurg 106(2):222–225CrossRefPubMedGoogle Scholar
  41. 41.
    Mazighi M, Yadav JS, Abou-Chebl A (2008) Durability of endovascular therapy for symptomatic intracranial atherosclerosis. Stroke 39(6):1766–1769CrossRefPubMedGoogle Scholar
  42. 42.
    Kurre W, Berkefeld J, Sitzer M, Neumann-Haefelin T, de Rochemont R (2008) Treatment of symptomatic high-grade intracranial stenoses with the balloon-expandable Pharos stent: initial experience. Neuroradiology 50(8):701–708CrossRefPubMedGoogle Scholar
  43. 43.
    Zhao ZW, Deng JP, He SM, Qin HZ, Gao L, Gao GD (2009) Intracranial angioplasty with Gateway-Wingspan system for symptomatic atherosclerotic stenosis: preliminary results of 27 Chinese patients. Surg Neurol 72(6):607–611CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • S. Lanfranconi
    • 1
    • 2
  • A. Bersano
    • 1
    • 2
  • V. Branca
    • 3
  • E. Ballabio
    • 1
    • 2
  • M. Isalberti
    • 3
  • R. Papa
    • 3
  • L. Candelise
    • 1
    • 2
  1. 1.Centro Dino FerrariUniversità degli Studi di MilanoMilanItaly
  2. 2.Neurology UnitFondazione IRCCS Cà Granda, Ospedale Maggiore PoliclinicoMilanItaly
  3. 3.Department of Diagnostic and Interventional NeuroradiologyFondazione IRCCS Cà Granda, Ospedale Maggiore PoliclinicoMilanItaly

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