Abstract
Purpose
The aim of the study was to retrospectively evaluate the safety and efficacy of stent angioplasty of symptomatic intracranial stenosis in a single center experience.
Materials and methods
Between November 2006 and September 2009 a total of 54 stent angioplasties were performed in 49 patients and of these 46 were done for symptomatic intracranial high-grade (>70%) stenoses and 8 for complete vessel occlusions in acute stroke. All elective treatments were carried out with patients under antithrombotic/anticoagulant medication. Self-expandable stents were used in 42 cases and balloon-expandable stents in 12 cases.
Results
Stent angioplasty was successful in 53 out of 54 cases (98%). Periprocedural complications occurred in 6 patients, including 2 dissections, 1 contrast-mediated toxic reaction and 1 thromboembolic event with transient neurological deficits but did not cause permanent neurological deficits, in any of the cases.
Adverse events within 30 days after intervention occurred in 11 of the 49 patients (20.4%) of which 4 were scheduled patients (8.3%) and 7 were treated for acute stroke with complete vessel occlusions (87.5%). Overall there were 9 cases of restenosis (7 out of 9 >90% stenoses and 2 complete vessel occlusions), 5 out of 9 were asymptomatic, 4 out of 9 had a transient ischemic attack and 1 developed a major stroke. Two complete in-stent thromboses were seen in acute stroke patients with initial complete occlusion within 24 h after recanalization. One restenosis and one complete occlusion occurred under double antiplatelet medication, 4 out of 9 restenoses occurred under aspisol medication and 3 out of 9 after antiplatelet medication was discontinued. In 2 out of 9 restenoses, balloon-expandable stents had been used, the remaining 7 had been treated with self-expanding stents, 5 out of 9 restenoses were treated by balloon-angioplasty alone, in 3 out of 9 an additional stent had to be placed and 1 asymptomatic occlusion was left untreated.
Conclusions
The results demonstrate the technical feasibility and satisfactory success rates of stent angioplasty in intracranial atherosclerotic stenoses. The procedural success rate was 98% and the overall rate of adverse events was 20.4%. The rate of adverse events was high in unstable patients (87.5%) treated without antiplatelet premedication, especially in the setting of an acute stroke. In stable patients the rate of adverse events was much lower (8.3%). Future development of dedicated stents and a better understanding of factors that predispose to restenosis may help to further decrease the rate of periprocedural and postprocedural adverse events thus helping to improve both short-term and long-term outcome after intracranial stent angioplasty.
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References
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(1):14–20.
Kasner SE, Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, et al. Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation. 2006;113:555–63.
The EC/IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: Results of an international randomized trial. N Engl J Med. 1985;313:1191–2120.
Berg-Dammer E, Henkes H, Weber W, Berlit P, Kühne D. Percutaneous transluminal angioplasty of intracranial artery stenosis: clinical results in 24 patients. Neurosurg Focus. 1998;15:e1.
Mazihi M, Yadav JS, Abou-Chebl A. Durability of endovascular therapy for symptomatic intracranial atherosclerosis. Stroke. 2008;39:1766–9.
Dorn F, Castrop F, Zimmer C, Liebig T. Cortical laminar necrosis after carotid stenting. Klin Neuroradiol. 2009;19(4):297–300.
Gröschel K, Schnaudigel S, Pilgram SM, Wasser K, Kastrup A. A systematic review on outcome after stenting for intracranial atherosclerosis. Stroke. 2009;40(5):e340–7.
Kastrup, Zaidat OO, Klucznik R, Alexander MJ, Chaloupka J, Lutsep H, et al. The NIH registry on use of the Wingspan stent for symptomatic 70–99% intracranial arterial stenosis. Neurology. 2008;70:1518–24.
Bose A, Hartmann M, Henkes H, Liu HM, Teng MM,Szikora I, et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke. 2007;38(5):1531–7.
Berkefeld J, Hamann GF, du Mesnil R, Kurre W, Steinmetz H, Zanella FE, et al. Endovascular treatment for intracranial stenoses. A common statement by neurologists and neuroradiologists. Nervenarzt. 2006;77(12):1444–55.
National Institute of Neurological Disorders and Stroke (NINDS). Clinical alert: Angioplasty Combined with Stenting Plus Aggressive Medical Therapy vs. Aggressive Medical Therapy Alone for Intracranial Arterial Stenosis: NINDS Stops Trial Enrollment Due to a Higher Risk of Stroke and Death in the Stented Group. www.ninds.nih.gov.
Gupta R, Al-Ali F, Thomas AJ, Horowitz MB, Barrow T, Vora NA, et al. Safety, feasibility, and short-term follow-up of drug-eluting stent placement in the intracranial and extracranial circulation. Stroke. 2006;37(10):2562–6.
Steinfort B, Ng PP, Faulder K, Harrington T, Grinnell V, Sorby W, et al. Midterm outcomes of paclitaxel-eluting stents for the treatment of intracranial posterior circulation stenoses. J Neurosurg. 2007;106:222–5.
Dogan A, Fields J, Petersen B, Lee D, Nesbit G, Clark W, et al. Drug eluting stents for symptomatic intracranial and vertebral artery stenosis: a single center experience with high rates of clinical and angiographic follow-up. Intervent Neuroradiol. 2009;15(Suppl 1):98.
Gröschel K, Riecker A, Schulz JB, Ernemann U, Kastrup A. Systematic review of early recurrent stenosis after carotid angioplasty and stenting. Stroke. 2005;36:367–73a.
SSYLVIA Study Investigators. Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA). Stroke. 2004;35:1388–1392.
Jiang WJ, Xu XT, Jin M, Du B, Dong KH, Dai JP. Apollo stent for symptomatic atherosclerotic intracranial stenosis: study results. AJNR Am J Neuroradiol. 2007;28:830–4.
Puetz V, Gahn G, Becker U, Mucha D, Mueller A, Weir NU, et al. Endovascular therapy of symptomatic intracranial stenosis in patients with impaired regional cerebral blood flow or failure of medical therapy. AJNR Am J Neuroradiol. 2008;29:273–80.
Kurre W, Berkefeld J, Sitzer M, Neumann-Haefelin T, Du Mesnil De Rochemont R. Treatment of symptomatic high-grade intracranial stenoses with the balloon-expandable Pharos stent: initial experience. Neuroradiology. 2008;50:701–8.
Suh DC, Kim JK, Choi JW, Choi BS, Pyun HW, Choi YJ, et al. Intracranial stenting of severe symptomatic intracranial stenosis: results of 100 consecutive patients. AJNR Am J Neuroradiol. 2008;29:781–5.
Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, Pride L, et al. Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management. Neurosurgery. 2007;61:644–50.
Turk AS, Levy EI, Albuquerque FC, Pride GL Jr, Woo H, Welch BG, et al. Influence of patient age and stenosis location on wingspan in-stent restenosis. AJNR Am J Neuroradiol. 2008;29:23–7.
Berkefeld J, Zanella FE. Intracranial stenting of atherosclerotic stenoses: current status and perspectives. Klin Neuroradiol. 2009;19;38–44.
Wittkugel O, Rosenkranz M, Burckhardt D, Niessen WD, Espersen T, Zeumer H, et al. Long-term outcome after endovascular treatment of high-risk patients with recurrently symptomatic intracranial stenoses of the posterior circulation. Rofo. 2009;181(8):782–91.
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The authors declare that there is no current or potential conflict of interest in relation to this article.
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Dorn, F., Prothmann, S., Wunderlich, S. et al. Stent Angioplasty of Intracranial Stenosis. Clin Neuroradiol 22, 149–156 (2012). https://doi.org/10.1007/s00062-011-0106-1
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DOI: https://doi.org/10.1007/s00062-011-0106-1