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Sun Y, Luo J, Gong H, Xu R, Zhang X, Yang B, Ma Y, Wang T, Jiao L. Comparison of drug-coated balloon angioplasty versus standard medical therapy on recurrent stroke and mortality rates among patients with symptomatic intracranial atherosclerotic stenosis: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e078040. [PMID: 38016792 PMCID: PMC10685973 DOI: 10.1136/bmjopen-2023-078040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION Stroke remains the second leading cause of death worldwide, a common cause of which is intracranial atherosclerotic stenosis (ICAS). Medical treatment is recommended as first-line therapy for treating ICAS, but the recurrence rate remains high. Drug-coated balloon (DCB) angioplasty has been designed to lower the risk of recurrent stenosis, holding therapeutic promise in the treatment of ICAS. However, the benefits of DCB require further evaluation. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols was followed to develop this protocol. We will systematically search online databases including Cochrane Central Register of Controlled Trials, PubMed, Web of Science, EMBASE, China Biological Medicine Database, ClinicalTrials.gov and WHO ICTRP from 1 January 2011 to the date of search. This will be supplemented by a manual search of unpublished and ongoing trials to manually select articles for inclusion. Inclusion criteria are randomised or quasi-randomised clinical trials and observational studies that investigated DCB or medical treatment for patients with a symptomatic ICAS of 50%-99%. The primary outcome is short-term composite safety including death of any cause, or non-fatal stroke. Secondary outcomes include long-term death or stroke, restenosis, neurological rehabilitation, quality of life and other complications. The available data will be analysed using meta-analysis, if appropriate. The evaluation of heterogeneity and biases will be guided by the Cochrane Handbook for Systematic Reviews of Interventions. ETHICS AND DISSEMINATION This systematic review does not require ethical approval as all available data from eligible studies will be anonymous with no concerns regarding privacy. Our findings will be disseminated through international conferences and peer-reviewed publications. Additional data from the study are available on request to corresponding authors via email. PROSPERO REGISTRATION NUMBER CRD42022341607.
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Affiliation(s)
- Yixin Sun
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- Peking University First Hospital, Beijing, China
- Health Science Center, Peking University, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Haozhi Gong
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Ran Xu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China
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Zhao Z, Liang W, Yan L, Zhang K, Kong H, Mang J. Optional or optimal? off-label stenting for intracranial atherosclerotic stenosis: A scoping review. Interv Neuroradiol 2023:15910199231171811. [PMID: 37122266 DOI: 10.1177/15910199231171811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Intracranial atherosclerotic stenosis is a major cause of ischemic stroke. In addition to the Wingspan stent system, several self-expanding stents have been used off-label to treat intracranial atherosclerotic stenosis lesions. The purpose of this review is to assess the existing data on the off-label use of self-expanding stents in intracranial atherosclerotic stenosis, to highlight methodological limitations in current study designs, and thus providing strategies and precautions for clinical practice. METHODS The PubMed, EMBASE, and the Cochrane Library databases were systematically searched for relevant articles published up to April 2022. In addition to the meta analysis of Enterprise, Neuroform EZ and closed cell stent respectively, we used a narrative synthesis to summarize and discuss the appropriate strategies and precautions for the use of each stent. RESULTS We identified 17 studies (1091 patients with 1124 lesions) reporting 6 types of off-label self-expanding stents. The most common endpoints reported were incidence of short-term complications (range: 0-15.8%, median: 3.8%), long-term complications (range: 0-12.0%, median: 0%). Potential risks include infeasibility of stenting hard lesions or tortuous vessels, stent migration, and in-stent thrombosis. Less is known about the conditions that are appropriate for an optimal stent (e.g., open-cell, close-cell, hybrid cell). There was considerable heterogeneity across studies with regards to study populations and study designs. CONCLUSIONS The potential risks and benefits should be carefully considered when using off-label stents for intracranial atherosclerotic stenosis, particularly given the current evidence power. As a potential option for the Wingspan stent, based on device's approval only, a tailored approach with lesion-specific devices could be beneficial in certain patients.
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Affiliation(s)
- Zhongyu Zhao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin, Changchun, China
| | - Wenzhao Liang
- Department of Geriatric Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lei Yan
- Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin, Changchun, China
| | - Kai Zhang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin, Changchun, China
| | - Huijing Kong
- Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin, Changchun, China
| | - Jing Mang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Jilin, Changchun, China
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Wang M, Leng X, Mao B, Zou R, Lin D, Gao Y, Wang N, Lu Y, Fiehler J, Siddiqui AH, Wu J, Xiang J, Wan S. Functional evaluation of intracranial atherosclerotic stenosis by pressure ratio measurements. Heliyon 2023; 9:e13527. [PMID: 36852079 PMCID: PMC9958418 DOI: 10.1016/j.heliyon.2023.e13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/09/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Background Fractional flow reserve is widely used for the functional evaluation of coronary artery stenosis. Some studies have similarly used the translesional pressure ratio measurements for the functional evaluation of intracranial atherosclerotic stenosis. In this paper, we aimed to investigate the relationship between pressure ratio and cerebral tissue perfusion by MR perfusion imaging and provided a non-invasive method for evaluating the functional significance of intracranial atherosclerotic stenosis. Methods A total of 18 consecutive patients with intracranial atherosclerotic stenosis patients including 19 stenotic vessels were recruited. The pressure was measured using a pressure guidewire, the pressure ratio before and after the endovascular intervention was calculated and compared with the severity of diameter stenosis and perfusion-derived MR (the time to maximum tissure residue function (Tmax)). Moreover, the DSA-derived pressure ratio was computed using a novel computational fluid dynamics-based model, termed CFD-PR, and was compared with the actual pressure ratio to assess its diagnostic accuracy. Results The pressure ratio increased after percutaneous transluminal angioplasty or stenting, while the correlation between pressure ratio and diameter stenosis was not significant. The pressure ratio was negatively correlated with Tmax (r = -0.73, P < 0.01), and a 95% confidence interval for the cutoff value of pressure ratio = 0.67 (95% confidence interval: 0.58-0.76) was suggested. There was a good correlation (mean = 0.02, Spearman's correlation coefficient r = 0.908, P < 0.001) and agreement (limits of agreement: -0.157 to 0.196, P = 0.954) between CFD-PR and the actual pressure ratio. Conclusions This exploratory study indicates the pressure ratio may correlate with the perfusion status. The pressure ratio can be calculated through a non-invasive method using a computational fluid dynamics-based method.
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Affiliation(s)
- Ming Wang
- Brain Center, Zhejiang Hospital, Hangzhou, China
| | | | - Baojie Mao
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | - Dongdong Lin
- Brain Center, Zhejiang Hospital, Hangzhou, China
| | - Yuhai Gao
- Brain Center, Zhejiang Hospital, Hangzhou, China
| | - Ning Wang
- Brain Center, Zhejiang Hospital, Hangzhou, China
| | - Yuning Lu
- Brain Center, Zhejiang Hospital, Hangzhou, China
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Adnan H Siddiqui
- Department of Neurosurgery and Radiology, University at Buffalo, Buffalo, NY, USA
| | - Jiong Wu
- Brain Center, Zhejiang Hospital, Hangzhou, China
| | | | - Shu Wan
- Brain Center, Zhejiang Hospital, Hangzhou, China
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Mao LL, Ma AJ, Liu ZQ, Zhang J, Xu YF, Chen WY, Cao YJ. A retrospective study of individualized endovascular treatment for symptomatic intracranial atherosclerotic stenosis in patients with ischemic stroke/transient ischemic attack. Front Neurol 2022; 13:1057935. [PMID: 36530619 PMCID: PMC9748557 DOI: 10.3389/fneur.2022.1057935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/16/2022] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Endovascular treatment (EVT) is one of the effective treatment procedure for the symptomatic intracranial atherosclerotic stenosis (sICAS). AIM AND METHODS We evaluated the efficacy and safety of individualized endovascular treatment for sICAS patients. Clinical and imaging follow-ups were carried out to collect the data of 29 sICAS patients after 6 months of individualized endovascular treatment. Different treatment strategies are selected based on arterial access and lesion morphology of patients. If standard surgical path, narrow artery straight, stenosis length ≤10 mm, then the appropriate specifications of balloon-mounted stent (BMS) treatment. the surgical path is tortuous, the narrow artery is curved, the angle is apparent, the diameter of the near and far ends is significantly different, or the length of the stenosis is >10 mm, self-expanding stent (SES) with appropriate specifications is selected for treatment. If the narrowed artery is hyper flexed and the surgeon deems stenting inappropriate, balloon dilation angioplasty (BDA) treatment is chosen. RESULTS AND CONCLUSION 31 lesions of 29 sICAS patients received endovascular treatment. The median age was 61 years (IQR 54-69 years). The median preoperative stenosis was 90% (IQR 80-95%), and the mean stenosis length was (8.10 ± 3.27) mm. The most commonly used surgical procedure was Balloon-Mounted Stent (BMS) in 19 cases (65.52%), Self-expanding Stent (SES) in seven cases (24.14%), Balloon Dilation Angioplasty (BDA) in three cases (10.34%). (11.86 + 1.46 mm) was greater than that in the BMS group (6.14 + 1.59 mm) (P < 0.001). The median stenosis was 90% (IQR 80-92.5%) in the BMS group, lower than 99% (IQR 95-100%) in the SES group (P < 0.001). The median post-operative residual stenosis was 20% (IQR 15-25%), significantly improved compared with preoperative (P < 0.001). The success rate of the surgical technique was 93.10% (27/29). One patient (3.45%) had IS recurrence within 48 h after surgery, and the restenosis rate within 6 months after surgery was 6.90% (2/29). No patient died or had recurrent IS. Our data demonstrated that individualized endovascular treatment method could be potentially significant and safe for sICAS patients. This study will provide an important reference for the endovascular treatment of sICAD.
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Affiliation(s)
- Lun-Lin Mao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Ai-Jin Ma
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Zhi-Qing Liu
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Jin Zhang
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Yuan-Feng Xu
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Wen-Ya Chen
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Yong-Jun Cao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Machado M, Borges de Almeida G, Sequeira M, Pedro F, Fior A, Carvalho R, Fragata I, Reis J, Nunes AP. Percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease: The experience of a single stroke centre. Interv Neuroradiol 2022; 28:547-555. [PMID: 34704502 PMCID: PMC9511620 DOI: 10.1177/15910199211051830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Percutaneous transluminal angioplasty and stenting in acute stroke due to severe basilar artery stenosis or basilar artery occlusion remain a matter of debate. The higher risk of stroke recurrence in patients with vertebrobasilar stenosis compared to anterior circulation atherosclerotic disease creates high expectations concerning endovascular approaches. This study aims to review our experience with percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease. METHODS Our prospective database from June 2014 until December 2020 was screened and patients with acutely symptomatic severe (>80%) basilar artery stenosis or acute basilar artery occlusion who underwent percutaneous transluminal angioplasty and stenting were analysed. RESULTS Twenty-five patients included: 72% men (mean age 68.6 years), all with prior modified Rankin Scale <2. Twelve presented with acute basilar artery occlusion and were submitted to mechanical thrombectomy before percutaneous transluminal angioplasty and stenting, while the remaining had severe basilar artery stenosis. Successful stent placement was achieved in 22 (88%). Procedure-related complications included new small ischemic lesions (16%), basilar artery dissection (8%), vertebral artery dissection (12%) and death (12%). At 3 months post-percutaneous transluminal angioplasty and stenting, 10 out of 23 patients (43.5%) were independent (mRS ≤ 2) and six died. Fourteen patients underwent transcranial Doppler ultrasound 3 months post-percutaneous transluminal angioplasty and stenting: 12 showed residual stenosis, one significant stent restenosis and one presented stent occlusion. CONCLUSIONS Percutaneous transluminal angioplasty and stenting showed to be a technically feasible and reasonably safe procedure in selected patients. However, good clinical outcomes may be difficult to achieve as only 43.5% of the patients remained independent at 3 months. Randomized studies are needed to confirm the efficacy and safety outcomes of percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease.
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Affiliation(s)
- Manuel Machado
- Unidade Cerebrovascular, Departamento de Neurociências do, Centro Hospitalar e Universitário de Lisboa Central, Portugal
| | - Gonçalo Borges de Almeida
- Serviço de Neurorradiologia, Departamento de Neurociências do, Centro Hospitalar e Universitário de Lisboa Central, Portugal
| | - Marta Sequeira
- Unidade Cerebrovascular, Departamento de Neurociências do, Centro Hospitalar e Universitário de Lisboa Central, Portugal
| | - Filipa Pedro
- Serviço de Medicina Interna, Hospital Distrital de Santarém, Portugal
| | - Alberto Fior
- Unidade Cerebrovascular, Departamento de Neurociências do, Centro Hospitalar e Universitário de Lisboa Central, Portugal
| | - Rui Carvalho
- Serviço de Neurorradiologia, Departamento de Neurociências do, Centro Hospitalar e Universitário de Lisboa Central, Portugal
| | - Isabel Fragata
- Serviço de Neurorradiologia, Departamento de Neurociências do, Centro Hospitalar e Universitário de Lisboa Central, Portugal
| | - João Reis
- Serviço de Neurorradiologia, Departamento de Neurociências do, Centro Hospitalar e Universitário de Lisboa Central, Portugal
| | - Ana Paiva Nunes
- Unidade Cerebrovascular, Departamento de Neurociências do, Centro Hospitalar e Universitário de Lisboa Central, Portugal
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Lee JS, Lee SJ, Hong JM, Alverne FJAM, Lima FO, Nogueira RG. Endovascular Treatment of Large Vessel Occlusion Strokes Due to Intracranial Atherosclerotic Disease. J Stroke 2022; 24:3-20. [PMID: 35135056 PMCID: PMC8829471 DOI: 10.5853/jos.2021.01375] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Mechanical thrombectomy (MT) has become the gold-standard for patients with acute large vessel occlusion strokes (LVOS). MT is highly effective in the treatment of embolic occlusions; however, underlying intracranial atherosclerotic disease (ICAD) represents a therapeutic challenge, often requiring pharmacological and/or mechanical rescue treatment. Glycoprotein IIb/IIIa inhibitors have been suggested as the best initial approach, if reperfusion can be achieved after thrombectomy, with angioplasty and/or stenting being reserved for the more refractory cases. In this review, we focus on the therapeutic considerations surrounding the endovascular treatment of ICAD-related acute LVOS.
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Affiliation(s)
- Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Seong-Joon Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | | | | | - Raul G. Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, UPMC Stroke Institute, Pittsburg, PA, USA
- Correspondence: Raul G. Nogueira Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, UPMC Stroke Institute, C-400 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA Tel: +1-412-647-8080 Fax: +1-412-647-8445 E-mail:
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Li G, Qiao H, Lin H, Wang R, Chen F, Li S, Yang W, Yin L, Cen X, Zhang Y, Cheng X, Wang AYC. Application of drug-coated balloons for intracranial atherosclerosis disease: a systematic review. Clin Neurol Neurosurg 2021; 213:107065. [PMID: 34991058 DOI: 10.1016/j.clineuro.2021.107065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although percutaneous transluminal angioplasty and stenting (PTAS) was an effective and safe alternative treatment for severe intracranial atherosclerosis disease (ICAD), the high rate of restenosis remained a major issue for this endovascular procedure. Recently, the application of drug-coated balloons (DCB) in ICAD was developed to reduce restenosis. This systematic review aimed to evaluate the efficacy and safety of DCB angioplasty for ICAD. METHODS We searched relevant databases for eligible studies enrolling ICAD patients treated with DCB. The event rates of restenosis and periprocedural complications in the follow-up period were pooled with random-/fixed-effect models using Freeman-Tukey double arcsine transformation. Heterogeneity tests and publication bias tests were performed. RESULTS Two hundred and twenty-four ICAD patients treated with DCB from 9 eligible studies were included. Rate of stenosis in the DCB arm before treatment was ranged from 62% to 90% and reported median follow-up was ranged from 3 to 10.7 months. The pooled incidence of restenosis were 5.7% (95% confidence interval [CI] 2.6%-9.7%; I2 = 0%, p = 0.516) and 5.9% for periprocedural complications (95% CI: 2.5-10.3%; I2 = 0%, p = 0.649) in follow-up term. CONCLUSION With the limitation of the low quality of the available evidence, angioplasty with DCB appears to be effective and safe in severe ICAD. Further larger randomized trials are needed to provide more definitive evidence and to address the ideal clinical context for their application.
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Affiliation(s)
- Guoming Li
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Hanzi Qiao
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Hao Lin
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Rongfei Wang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Fajun Chen
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Shaoxue Li
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Weilin Yang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Lei Yin
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Xuecheng Cen
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Yingguang Zhang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Xiao Cheng
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China; Guangdong Provincial Chinese Emergency Key Laboratory, Guangzhou 510120, China; Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510006, China.
| | - Alvin Yi-Chou Wang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
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Wang XF, Wang M, Li G, Xu XY, Shen W, Liu J, Xiao SS, Zhou JH. Efficacy of Solitaire AB stent-release angioplasty in acute middle cerebral artery atherosclerosis obliterative cerebral infarction. World J Clin Cases 2021; 9:5028-5036. [PMID: 34307553 PMCID: PMC8283618 DOI: 10.12998/wjcc.v9.i19.5028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In both national and international studies, the safety and effectiveness of treatment with the Solitaire stent in patients with ischemic stroke caused by acute large vessel occlusion were good, and the disability rate was significantly reduced. However, there are currently only a few reports on the differences in endovascular treatment for different etiological classifications, especially in the anterior cranial circulation, aorta atherosclerotic stenosis, and acute thrombosis.
AIM To investigate the efficacy of Solitaire AB stent-release angioplasty in patients with acute middle cerebral artery atherosclerosis obliterative cerebral infarction.
METHODS Twenty-five patients with acute middle cerebral atherosclerosis obliterative cerebral infarction were retrospectively enrolled in this study from January 2017 to December 2019. The Solitaire AB stent was used to improve anterior blood flow to maintain modified cerebral infarction thrombolysis [modified thrombolysis in cerebral infarction (mTICI)] at the 2b/3 level or above, the stent was then unfolded and released.
RESULTS All 25 patients underwent successful surgery, with an average recanalization time of 23 min. One patient died of cerebral hemorrhage and cerebral herniation after the operation. The National Institutes of Health Stroke Scale (NIHSS) scores immediately after surgery (7.5 ± 5.6), at 24 h (5.5 ± 5.6) and at 1 wk (3.6 ± 6.7) compared with the preoperative NIHSS score (15.9 ± 4.4), were significantly different (P < 0.01). One case of restenosis was observed 3 mo after surgery (the stenosis rate was 50% without clinical symptoms), the modified Rankin scale scores were 0 points in 14 cases (56%), 1 point in 4 cases (16%), 2 points in 2 cases (8%), 3 points in 3 cases (12%), 4 points in 1 case (4%), and 6 points in 1 case (4%).
CONCLUSION In acute middle cerebral artery atherosclerosis obliterative cerebral infarction, when the Solitaire AB stent is unfolded and the forward blood flow is maintained at mTICI level 2b/3 or higher, stent release may be a safe and effective treatment method; however, long-term observation and a larger sample size are required to verify these findings.
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Affiliation(s)
- Xi-Feng Wang
- Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China
| | - Ming Wang
- Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China
| | - Gang Li
- Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China
| | - Xue-Yu Xu
- Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China
| | - Wei Shen
- Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China
| | - Jing Liu
- Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China
| | - Shuang-Shuang Xiao
- Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China
| | - Jiang-Hong Zhou
- Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China
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9
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Tang H, Lu Z, Zeng Z, Zuo Q, Li Q, Xu F, Huang Q, Liu J. Endovascular treatment of symptomatic intracranial atherosclerotic stenosis with low profile visualized intraluminal support stent. J Clin Neurosci 2021; 90:256-261. [PMID: 34275559 DOI: 10.1016/j.jocn.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Severe intracranial atherosclerotic stenosis has become one of the main causes resulting transient ischemic attack and stroke. This study aimed to evaluate the efficacy and safety of low profile visualized intraluminal support (LVIS) stent in treating symptomatic intracranial atherosclerotic stenosis. METHODS Data of 31 patients with at least 70% stenosis treated with LVIS stent in our center were retrospectively collected between July 2017 and November 2020. Further evaluation of lesion characteristics, technical success rate, preoperative complication, clinical and angiographic follow-up outcome, delayed in-stent stenosis were conducted. RESULTS Stent delivery and deployment were successfully achieved in all 31 patients (100%). 22 cases (71%) were located in anterior circulation and 9 cases (29%) were located in posterior circulation. The mean degree of stenosis lesion before stent deployment was 85.6 ± 9.4%, while after stenting was 11.2 ± 11.8%. One patient suffered from ischemic complication in stenting procedure, and timely delivery of rt-PA successfully recanalized the artery. Clinical follow-up was available in all 31patients (100%) with mean follow-up time 15.0 ± 12.1(3-45) months. No patients experienced the recurrence of stroke or TIA or death after discharge. Angiographic follow-up was available in 21patients (67.7%) with mean follow-up time 11.43 ± 6.8 (6-36) months. 19 patients (90.5%) were stable while 2 patients (9.5%) developed ISR in their last angiographic follow-up. The 2 patients received balloon angioplasty and reached satisfactory results after retreatment. CONCLUSION This preliminary study suggests that LVIS stent deployment was a feasible approach in treating intracranial atherosclerotic stenosis with satisfactory procedure success rate, low complication rate and favorable long-term outcome.
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Affiliation(s)
- Haishuang Tang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China; Naval Medical Center of PLA, Navy Military Medical University, Shanghai 200050, People's Republic of China
| | - Zhiwen Lu
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
| | - Zhangwei Zeng
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
| | - Qiao Zuo
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
| | - Fengfeng Xu
- Naval Medical Center of PLA, Navy Military Medical University, Shanghai 200050, People's Republic of China.
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China.
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
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Shen S, Wang Y, He X, Ma N, Gao F, Song L, Sun X, Liu L, Miao Z, Duan H, Mo D. Thirty-Day and One-Year Outcomes of Endovascular Treatments for Severe Atherosclerotic Stenosis of Intracranial ICA: Results From a Single Center. Front Neurol 2021; 12:668868. [PMID: 34113312 PMCID: PMC8185297 DOI: 10.3389/fneur.2021.668868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Endovascular treatment for intracranial atherosclerotic stenosis (ICAS) has been developed. However, the intracranial internal carotid artery (ICA) presents a particular challenge due to the location and tortuous route, and the outcomes of endovascular treatment in patients with stenosis of the intracranial ICA still have not been reported. This article retrospectively investigated the 30-day and 1-year outcomes of tailored endovascular treatment for patients with severe intracranial ICA stenosis from a single center. Methods: Between June 2014 and December 2017, 96 consecutive patients with severe atherosclerotic stenosis (70-99%) of the intracranial ICA were managed with endovascular treatment in Beijing Tiantan Hospital. Three different kinds of treatments [angioplasty with balloon dilatation alone (BD group), balloon-mounted stent (BMS group), and self-expanding stent (SES group)] were performed according to the characteristics of the lesions. The primary endpoints included any stroke or death within 30 days and ipsilateral ischemic stroke afterwards within 1 year. Secondary endpoints included the revascularization success rate (residual stenosis <30%) and the restenosis rate (stenosis ≥ 50%) within 1 year. Results: The 30-day death rate was 0, and the stroke rate of all patients was 7.3% (7/96). The stroke rate was higher in the BD group (15.8%) and SES group (9.8%) than in the BMS group (0%) (p = 0.047). Thirteen (13.5%) patients suffered at least one onset of ischemic stroke in the ipsilateral ICA territory within 1 year, and there was no significant difference among the three groups (p = 0.165). The overall revascularization success rate was 93.8%, and the revascularization success rate was significantly higher in the SES group (100%) than in the BD group (78.9%) (p = 0.006). The restenosis rate of all patients within 12 months was 20.8%, and there was no significant difference among the three groups. Patients with Mori type C target lesions were more likely to suffer stroke within 30 days (25%) and restenosis within 1 year (31.3%). Conclusions: Both the 30-day and 1-year outcomes of tailored endovascular treatments seemed to be acceptable in the treatment of symptomatic atherosclerotic stenosis of the intracranial ICA. However, this needs to be confirmed by further investigation, preferably in large multicenter randomized controlled clinical trials.
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Affiliation(s)
- Shengli Shen
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Yingjin Wang
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Xudong He
- Department of Neurology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ligang Song
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuan Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lian Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongzhou Duan
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Cao X, Wang J, Tian C, Du Z, Su H, Liu X, Lv B, Yu S, Chen X, Hui F. Solitaire AB stent-angioplasty for stenoses in perforator rich segments: A single-center experience. Interv Neuroradiol 2020; 26:608-614. [PMID: 32842832 DOI: 10.1177/1591019920951651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vascular angioplasty and stenting of middle cerebral artery (MCA) and basilar artery (BA) stenoses are associated with poor clinical outcomes and high mortality rates thought to be related to the abundance of perforating arteries in those segments. This study explores the use of Solitaire AB as an off-label vascular stent to treat stenoses in the MCA and BA. METHODS Solitaire AB stents were placed during angioplasty and stenting of MCA and BA stenoses in patients at our department between January 2015 and May 2017 with 6-36 months follow-up. Operative results were assessed by follow-up angiography and transcranial doppler after the procedure. Neurologic status was evaluated before and after treatment according to the modified Ranking Scale (mRS). RESULTS A total of 32 patients were included in the study. Seventeen (53.12%) patients presented with MCA stenosis and 15 (46.87%) with BA stenosis. The 30-day rate of procedure-related complications was 3.1% (1/32). Post-stenting residual stenosis degrees ranged from 0% to 40% (mean 13.44% ± 10.66%). Mean degree of residual stenosis in 26 patients followed up by DSA was 8.64% ± 9.67%. The mRS 0-2 was achieved in all (100%) patients at 6-12 months post-procedure. CONCLUSIONS Our study indicates the off-label use of Solitaire AB for stenting is effective and safe for MCA and BA stenoses with high technical success and low complications. We recommend that lesion-specific therapy with an anatomically fitted stent design enables optimal treatment for intracranial stenosis.
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Affiliation(s)
- Xiangyu Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Chenglin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Zhihua Du
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Hui Su
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xinfeng Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Bin Lv
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xing Chen
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Ferdinand Hui
- Department of Radiology, Johns Hopkins Hospital, Baltimore, USA
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12
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Peng G, Zhang Y, Miao Z. Incidence and Risk Factors of In-Stent Restenosis for Symptomatic Intracranial Atherosclerotic Stenosis: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2020; 41:1447-1452. [PMID: 32732271 DOI: 10.3174/ajnr.a6689] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/22/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND In-stent restenosis affects long-term outcome in patients with intracranial atherosclerotic stenosis. PURPOSE The aim of this meta-analysis was to evaluate the incidence and risk factors of in-stent restenosis. DATA SOURCES All literature that reported in-stent restenosis was searched on PubMed, Ovid EMBASE and Ovid MEDLINE data bases. STUDY SELECTION Original articles about stents for symptomatic intracranial atherosclerotic stenosis were selected. DATA ANALYSIS Meta-analysis was conducted to derive the pooled in-stent restenosis using a random-effects model. Meta-regression was performed to explore the risk factors predisposing to in-stent restenosis. DATA SYNTHESIS In total, 51 studies with 5043 patients were included. The pooled incidence rate of in-stent restenosis was 14.8% (95% CI, 11.9%-17.9%). Among the lesions with in-stent restenosis, 28.8% of them led to (95% CI, 22.0%-36.0%) related neurologic symptoms. The series in the United States had a higher in-stent restenosis rate (27.0%; 95% CI, 20.6%-33.9%) compared with those from Asia (13.6%; 95% CI, 10.3%-17.2%) and other regions as a whole (7.6%; 95% CI, 1.1%-18.1%) (P < .01). Multiregression analysis revealed that younger patient age was related to high in-stent restenosis rates (P = .019), and vertebrobasilar junction location (P = .010) and low residual stenosis (P = .018) were 2 independent risk factors for symptomatic in-stent restenosis rate. LIMITATIONS The heterogeneity of most outcomes was high. CONCLUSIONS Our study showed promising results of in-stent restenosis for symptomatic atherosclerotic stenosis. Studies are needed to further expatiate on the mechanisms by which younger patient age, vertebrobasilar junction location, and low residual stenosis could increase in-stent restenosis and symptomatic in-stent restenosis, respectively.
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Affiliation(s)
- G Peng
- From the Interventional Neuroradiology Center (G.P., Y.Z., Z.M.), Beijing Tiantan Hospital
| | - Y Zhang
- From the Interventional Neuroradiology Center (G.P., Y.Z., Z.M.), Beijing Tiantan Hospital.,Beijing Neurosurgical Institute (Y.Z.), Capital Medical University, Beijing, China
| | - Z Miao
- From the Interventional Neuroradiology Center (G.P., Y.Z., Z.M.), Beijing Tiantan Hospital .,China National Clinical Research Center for Neurological Diseases (Z.M.), Beijing, China
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13
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Thirty-Day Outcomes of the Enterprise Stent in Treating Hypoperfusion of Symptomatic Intracranial Stenosis. World Neurosurg 2019; 129:e429-e435. [PMID: 31150855 DOI: 10.1016/j.wneu.2019.05.167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the 30-day outcomes of using the Enterprise stent to treat patients with hypoperfusion of symptomatic severe intracranial stenosis. METHODS Patients with symptomatic severe intracranial stenosis (70%-99%) who underwent Enterprise stent intervention between August 2014 and November 2018 were retrospectively analyzed. The 30-day primary outcomes included the success rate of stenting and the incidence of complications, including ischemic stroke, cerebral hemorrhage, and death. The 30-day complication rates of patients with different lesion locations and classifications of Mori morphology were compared. RESULTS Sixty-eight patients were treated using 70 Enterprise stents. The success rate was 100%. The 30-day complication rate was 4.4%. The rates of ischemic stroke, cerebral hemorrhage, and death were 1.5%, 2.9%, and 0%, respectively. No significant difference was found in the 30-day complication rate between patients with different lesion locations and classifications of Mori morphology (P > 0.05). CONCLUSION Enterprise stents were relatively safe in treating patients with hypoperfusion of symptomatic severe intracranial stenosis.
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Xu H, Quan T, Zaidat OO, Chen D, Wang Z, Yuan Y, Yan B, Lu H, Guan S. Neuroform EZ Stenting for Symptomatic Intracranial Artery Stenosis: 30 Days Outcomes in a High-Volume Stroke Center. Front Neurol 2019; 10:428. [PMID: 31156528 PMCID: PMC6532552 DOI: 10.3389/fneur.2019.00428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/08/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To test whether Neuroform EZ stent placement combined with the modified techniques in symptomatic severe intracranial stenosis (ICAS) would result in lower rates of peri-procedural complications of intracranial stenting. Methods: We retrospectively reviewed the clinical data from 71 consecutive patients who underwent Neuroform EZ stent placement combined with the modified techniques for symptomatic severe ICAS at our institute between January 2016 and October 2017. The primary outcomes were ipsi-lateral ischemic stroke, intra-cerebral hemorrhage, or death within 30 days after stenting. The secondary outcome was technical success. Results: The technical success rate was 100%. The mean pre and post-stent stenoses were 84.2% ± 9.1% (median 85%, IQR75% to 90%) and 16.9% ± 10.2 % (median 15%, IQR 10% to 25%). The frequency of ipsi-lateral stroke, intra-cerebral hemorrhage, or death within 30 days was 0%. Conclusions: The combined use of Neuroform EZ stent placement and the modified techniques for symptomatic severe ICAS is technically feasible and safe, with very low peri-procedural complications. Further studies are required to assess the long-term results of this approach.
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Affiliation(s)
- Haowen Xu
- Departments of Interventional Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tao Quan
- Departments of Interventional Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Osama O Zaidat
- Departments of Endovascular Neurosurgery and Stroke, St. Vincent Mercy Medical Center, Toledo, OH, United States
| | - Dapu Chen
- Department of Neurosurgery, Second People's Hospital of Pingdingshan, Pingdingshan, China
| | - Zibo Wang
- Departments of Interventional Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongjie Yuan
- Departments of Interventional Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Baojun Yan
- Departments of Interventional Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hong Lu
- Departments of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sheng Guan
- Departments of Interventional Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Li DD, Huang H, Fang JH, Fu FW, Lin J, Bai GH, Xu SY, Sheng HS, Zhou Q, Zhang N, Yin B. Solitaire Stent Permanent Implantation as an Effective Rescue Treatment for Emergency Large Artery Occlusion. World Neurosurg 2019; 124:e533-e539. [PMID: 30664959 DOI: 10.1016/j.wneu.2018.12.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND In this study, we present our experiences on the feasibility of rescue permanent Solitaire stent placement for failed mechanical thrombectomy (MT) and our protocol to avoid ineffective stent placement. METHODS We retrospectively evaluated the data for consecutive patients admitted into the Second Affiliated Hospital of Wenzhou Medical University and 2 collaboration hospitals from August 2014 to May 2018 for emergency large artery occlusion. The baseline clinical characteristics and radiologic assessment, interventional data, clinical outcome, and angiographic follow-up data were assessed. Notably, we introduced our protocol for antegrade flow assessment before Solitaire stent detachment to ensure an effective stent implantation. RESULTS Thirty-nine patients (mean age, 68.1 years, mean preprocedural National Institute of Health Scale Score, 22.1) were included, in which 34 patients had anterior circulation large artery occlusion and 5 patients had posterior circulation large artery occlusion. The MT attempts ranged from 1-5 (3.6 on average). The mean onset-to-puncture time was 4.8 hours (ranging from 2.1-7.8 hours) and the mean procedure time was 87.4 minutes (ranging from 32-124 minutes). Modified thrombolysis in cerebral infarction 2b-3 reperfusions were noted in all cases. The immediate, average postprocedure stenosis rate was 25.3%, and the average stenosis rate at the 3-month angiographic follow-up was 34.7% (data from 15 patients). Three patients died. Nineteen (48.7%) patients had good outcome (modified Rankin Scale, mRS ≤2) at the 3-month follow-up. CONCLUSIONS Permanent Solitaire stent placement might be a feasible therapy for patients with MT-failed emergency large artery occlusion. For a successful revascularization, careful antegrade flow assessment before stent detachment is critical.
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Affiliation(s)
- Dan-Dong Li
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Huan Huang
- Department of Radiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Jun-Hao Fang
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Fang-Wang Fu
- Department of Neurology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Jian Lin
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Guang-Hui Bai
- Department of Radiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Shang-Yu Xu
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Han-Song Sheng
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Qian Zhou
- Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Nu Zhang
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Bo Yin
- Department of Neurosurgery, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China.
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Du Z, Mang J, Yu S, Tian C, Cao X, Liu X, Ma R, Zhang R, Lv B, Wang J. Weighing in on the Off-Label Use: Initial Experience of Neuroform EZ Stenting for Intracranial Arterial Stenosis in 45 Patients. Front Neurol 2018; 9:852. [PMID: 30364175 PMCID: PMC6191497 DOI: 10.3389/fneur.2018.00852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/21/2018] [Indexed: 11/30/2022] Open
Abstract
Background: The role of stenting for intracranial arterial stenosis (ICAS) has been increasingly debated due to negative results of randomized trials. Thus, exploration of more appropriate devices may hopefully shed light on the endovascular approach, especially for patients with recalcitrant ICAS related to a high risk of stroke. We sought to present and analyze the data of Neuroform EZ stenting for medically refractory ICAS in a single-center series. Materials and methods: Between November 2016 and January 2018, 45 consecutive patients treated with the Neuroform EZ stent were included in our retrospective study. Outcomes evaluation included successful procedure rate, vascular event within 30 days and recurrent stenosis for at least 6 months after the procedure. Results: The technical success rate was 100% for all 46 stenotic lesions. Mean pre-stent stenosis was 86.5 ± 8.7%, improving to 23.7 ± 18.1% after stenting. Combined procedure related vascular event rate was 2.2% (n = 1) within 30 days after the procedure. No in-stent restenosis was observed during an average follow-up period of 7.3 months. Conclusion: The Neuroform EZ stent system could serve as an off-label but promising optional device for ICAS stenting in a carefully selected subgroup of patients. Further longer-term clinical follow-up is mandatory to validate our initial results.
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Affiliation(s)
- Zhihua Du
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Jing Mang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Chenglin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xiangyu Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xinfeng Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Renzheng Ma
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Rongju Zhang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Bin Lv
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Litao MS, Nossek E, DeSousa K, Favate A, Raz E, Shapiro M, Becske T, Nelson PK. Permanent Deployment of the Solitaire FR™ Device in the Basilar Artery in an Acute Stroke Scenario. INTERVENTIONAL NEUROLOGY 2018; 7:6-11. [DOI: 10.1159/000480245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Background:</i></b> Scarce reports exist of permanent deployment of Solitaire FR™ devices for arterial steno-occlusive disease as it is primarily indicated for temporary deployment for thrombectomy in large-vessel, anterior-circulation ischemic strokes. Even more scarce are reports describing permanent deployment of the Solitaire device for posterior circulation strokes. <b><i>Summary:</i></b> We present 2 cases where the Solitaire device was electrolytically detached to re-establish flow in an occluded or stenotic basilar artery in acutely symptomatic patients. In both cases, a 4 × 15 mm Solitaire device was positioned across the stenotic or occluded portion of the basilar artery and electrolytically detached to maintain vessel patency. Both cases had good clinical outcomes with a National Institutes of Health Stroke Scale (NIHSS) score of 1 (from 24) on 90-day follow-up and an NIHSS score of 2 (from 7) on 30-day follow-up. <b><i>Key Messages:</i></b> Permanent deployment of the Solitaire device may potentially be a safe and effective means of maintaining vessel patency in an occluded or stenotic basilar artery.
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18
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Wan Y, Lo WT, Liu YX, Peng XX. Endovascular revascularization of symptomatic chronic middle cerebral artery occlusions: Two case reports. Interv Neuroradiol 2015; 22:84-7. [PMID: 26647227 DOI: 10.1177/1591019915617316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/01/2015] [Indexed: 11/16/2022] Open
Abstract
For patients with chronic middle cerebral artery occlusions who have recurrent ischemic symptoms despite antiplatelet therapy and vascular risk factor control, treatment options are limited. Because of concerns about the safety of endovascular revascularization of these occlusions and the technical skills required, these procedures have not been widely performed. We report on two patients with successful endovascular revascularization of the chronic middle cerebral artery occlusion with impaired cerebral hemodynamics, with vessel patency maintained on follow-up imaging and no recurrence of stroke. A literature review of treatment options for such patients was performed. Revascularization is technically feasible and can be considered an option for carefully selected chronic middle cerebral artery occlusion patients with recurrent ischemic symptoms despite medical therapy.
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Affiliation(s)
- Yue Wan
- Department of Interventional Neuroradiology, Zhongshan Hospital affiliated to Wuhan University, China
| | - Wai-Ting Lo
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - Yang-Xia Liu
- Department of Interventional Neuroradiology, Zhongshan Hospital affiliated to Wuhan University, China
| | - Xiao-Xiang Peng
- Department of Interventional Neuroradiology, Zhongshan Hospital affiliated to Wuhan University, China
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