Outcomes of tailored angioplasty and/or stenting for symptomatic intracranial atherosclerosis: a prospective cohort study after SAMMPRIS.

Abstract

BACKGROUND AND PURPOSE:

High periprocedural complication rate is a key limitation of endovascular treatment of intracranial atherosclerotic disease (ICAD), despite potential risk reduction of recurrent stroke. Taking lessons from the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Arterial Stenosis (SAMMPRIS) trial, targeting a selected patient population, we prospectively evaluated the feasibility and safety of tailored angioplasty and/or stenting for patients with ICAD.

METHODS:

From November 2011 to October 2012, 158 patients with symptomatic ICAD caused by hypoperfusion combined with poor collateral flow were consecutively recruited into a prospective single center study. Patients were divided into three groups based on arterial access and lesion morphology: balloon mounted stent group (group BS) for smooth access and Mori A lesion, angioplasty plus self-expanding stent group (group AS) for tortuous access and Mori B or C lesion, and angioplasty group (group AG) for tortuous access and Mori A lesion. The primary endpoints were successful procedure rate and any vascular event within 30 days.

RESULTS:

Overall technical success rate was 96.3% (154/158). There were significant differences in the technical success rate: 89.7% (35/39) in group AG compared with 97.5% (79/81) in group BS and 100% (38/38) in group AS (p=0.042). The 30 day composite stroke, myocardial infarction, or death rate was 4.4% (7/158). Stroke within 30 days occurred in four patients in group BS and in three patients in group AS.

CONCLUSIONS:

Individualized treatment of ICAD using tailored devices according to arterial access and lesion morphology was feasible and safe in symptomatic patients caused by hypoperfusion with poor collateral flow.

• Authors: Zhongrong Miao, Ligang Song, David S Liebeskind, Liping Liu, Ning Ma, Yilong Wang, Dapeng Mo, Feng Gao, Xingquan Zhao, Kehui Dong, Dong Zhang, Peiyi Gao
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 7 Issue 5 Pg. 331-5 (May 2015) ISSN: 1759-8486 [Electronic] England
• PMID: 24759694 (Publication Type: Journal Article)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Topics

• Adult
• Aged
• Angioplasty (adverse effects, instrumentation, methods, statistics & numerical data)
• Angioplasty, Balloon (adverse effects, instrumentation, methods, statistics & numerical data)
• Clinical Trials as Topic
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Intracranial Arteriosclerosis (epidemiology, therapy)
• Male
• Middle Aged
• Outcome Assessment, Health Care (statistics & numerical data)
• Postoperative Complications (epidemiology)
• Stents (adverse effects, statistics & numerical data)
• Stroke (epidemiology)