1
|
Mo D, Tong X, Li X, Qin C, Pan Y, Guan S, Miao Z. DRug-coated Balloon for Endovascular treatment of sYmptOmatic intracraNial stenotic Disease (DR. BEYOND): the protocol of a multicentre randomised trial. Stroke Vasc Neurol 2024:svn-2024-003259. [PMID: 39043584 DOI: 10.1136/svn-2024-003259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/06/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Although endovascular stenting is considered an effective and safe therapeutic option for symptomatic intracranial atherosclerotic disease (sICAD), an elevated rate of restenosis remains an important issue for the conventional bare-metal stent (BMS). Recent evidence from observational studies suggests that applying drug-coated balloons (DCB) in sICAD may decrease restenosis occurrence. Additional large randomised studies are warranted to provide firmer evidence and to determine which patients would benefit most from DCB. AIM To design a randomised trial to examine DCB angioplasty (Taijieweiye intracranial paclitaxel-coated balloon catheter) versus BMS stenting (Wingspan intracranial stent system) in patients with sICAD. DESIGN This is a multicentre, prospective, randomised, open-label, blinded end-point study to assess whether DCB angioplasty reduces the risk of restenosis compared with BMS stenting in sICAD patients with high-grade stenosis (≥70%-99%). Our goal is to randomly assign 198 eligible individuals at a 1:1 ratio to undergo DCB angioplasty (intervention group) or BMS stenting (control group). OUTCOME The primary efficacy outcome is restenosis at 6 months post treatment, that is, >50% stenosis in or within 5 mm of the treated segment and >20% absolute luminal loss. The primary safety outcome is stroke or death within 30 days post treatment. DISCUSSION The DRug-coated Balloon for Endovascular treatment of sYmptOmatic intracraNial stenotic Disease trial aims to produce strong evidence on the efficacy and safety of DCB angioplasty as a promising therapeutic option for sICAD cases with high-grade stenosis.
Collapse
Affiliation(s)
- Dapeng Mo
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqing Li
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuan Qin
- Department of Quality, Beijing Taijieweiye Technology Co., Ltd, Beijing, China
| | - Yuesong Pan
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sheng Guan
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongrong Miao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Li B, Bian Q, Li H, He Y, Chen S, Zhang K, Wang Z. Effect of Drug-Coated Balloon Versus Stent Angioplasty in Patients With Symptomatic Intracranial Atherosclerotic Stenosis. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01176. [PMID: 38781497 DOI: 10.1227/ons.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Drug-coated balloons (DCBs) have exhibited promising results in coronary and peripheral artery diseases, but conclusive evidence is lacking in intracranial vasculature. We assessed the safety and efficacy of DCBs vs stent angioplasty for symptomatic intracranial atherosclerotic stenosis (sICAS) and initially identified patients who might have benefited most from DCB treatment. METHODS A single-center, retrospective cohort study was conducted from June 2021 to May 2022 with 154 patients with sICAS divided into 2 treatment groups: a DCB group (with or without remedial stenting, n = 47) and a stent group (n = 107). The treatment outcomes were compared using 1:2 propensity score matching. The primary safety end point was perioperative stroke or mortality, and the primary efficacy end point was the rate of target vessel restenosis at 12 months. The degree of luminal change was analyzed as a subgroup, defined as the difference between the degree of stenosis at follow-up and immediately after intervention. RESULTS One hundred eighteen patients were enrolled using propensity score matching, with 43 patients in the DCB group and 75 in the stent group. The incidence of perioperative adverse events was 2.3% in the DCB group and 8.0% in the stent group (P = .420). At a median follow-up of 12 months, the incidence of restenosis (11.9% [5/43] vs 28.0% [21/75], P = .045) and the median degree of stenosis (30% [20%, 44%] vs 30% [30%, 70%], P = .009, CI [0-0.01, 0.2]) were significantly lower in the DCB group than in the stent group. DCB angioplasty effectively prevented adverse events in the target vessel area and significantly reduced the degree of luminal change in the M1 segment of the middle cerebral artery (0 [0, 15%] vs 10% [0, 50%], P = .016). CONCLUSION DCB angioplasty might be a safe and effective alternative to stent angioplasty to treat sICAS, particularly among patients with M1 segment of the middle cerebral artery stenosis.
Collapse
Affiliation(s)
- Bei Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Zhengzhou, Henan, P.R. China
| | - Qiang Bian
- Department of Pathophysiology, Weifang Medical University, Weifang, Shandong, P.R. China
| | - Heju Li
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
| | - Yingkun He
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
| | - Songtao Chen
- Cerebrovascular Department of Interventional Center, Henan University People's Hospital, Zhengzhou, Henan, P.R. China
| | - Kun Zhang
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
| | - Ziliang Wang
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
| |
Collapse
|
3
|
Qureshi AI, Lodhi A, Ma X, Ahmed R, Kwok CS, Maqsood H, Liaqat J, Hassan AE, Siddiq F, Gomez CR, Suri MFK. Self-expanding versus balloon expandable stent for intracranial arterial stenosis: A systematic review and meta-analysis. J Neuroimaging 2024; 34:295-307. [PMID: 38225680 DOI: 10.1111/jon.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND AND PURPOSE There are limited data regarding the comparison of balloon expandable stents (BES) and self-expanding stents (SES) for the treatment of intracranial arterial stenosis. METHODS We conducted a systematic review to identify studies that compared SES and BES in patients with symptomatic intracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until from January 1, 2010 to September 28, 2023. Statistical pooling with random-effects meta-analysis was undertaken to compare the rates/severity of postprocedure stenosis, technical success, 30-day stroke and/or death, cumulative clinical endpoints, and restenosis rates. RESULTS A total of 20 studies were included. The standardized mean difference (SMD) for postprocedure stenosis (%) was significantly lower (SMD: -0.52, 95% confidence interval [CI]: -0.79 to -0.24, p < .001, 10 studies involving 1515 patients) with BES. The odds for 30-day stroke and/or death were significantly lower (odds ratio [OR] 0.68, 95% CI: 0.50-0.94, p = .019, 15 studies involving 2431 patients), and cumulative clinical endpoints on follow-up were nonsignificantly lower (OR 0.64, 95% CI: 0.30-1.37, p = .250, 10 studies involving 947 patients) with BES. The odds for restenosis during follow-up were significantly lower (OR 0.50, 95% CI: 0.31-0.80, p = .004, 13 studies involving 1115 patients) with BES. CONCLUSIONS Compared with SES, BES were associated with lower rates of postprocedure 30-day stroke and/or death with lower rates of restenosis during follow up and the treatment of symptomatic intracranial arterial stenosis.
Collapse
Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Abdullah Lodhi
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Xiaoyu Ma
- Department of Biostatistics, University of Missouri, Columbia, Missouri, USA
| | - Rehan Ahmed
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Chun Shing Kwok
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Hamza Maqsood
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Jahanzeb Liaqat
- Department of Neurology, Pak Emirates Military Hospital Rawalpindi, Rawalpindi, Pakistan
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
| | - Farhan Siddiq
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Camilo R Gomez
- Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - M Fareed K Suri
- Stroke Program, St. Cloud Hospital, Minneapolis, Minnesota, USA
| |
Collapse
|
4
|
Tang Y, Li T, Liu W, He Y, Zhu L, Wang ZL, He Y. Comparison of drug-coated balloon with conventional balloon for angioplasty in symptomatic intracranial atherosclerotic stenosis. J Neurointerv Surg 2023; 15:e369-e374. [PMID: 36604174 DOI: 10.1136/jnis-2022-019685] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Drug-coated balloon (DCB) angioplasty has been studied for reducing the occurrence of restenosis after treatment for intracranial atherosclerotic stenosis (ICAS), but no comparison has been published of the use of drug-coated and non-coated balloons in angioplasty for ICAS. We aim to compare the safety and efficacy of DCB angioplasty with conventional balloon (CB) angioplasty for the treatment of symptomatic ICAS. METHODS One hundred cases with symptomatic ICAS treated with DCB (n=49) and CB (n=51) angioplasty were retrospectively analyzed. 1:1 propensity score matching (PSM) was completed to eliminate bias in the patients selected for further analysis. The periprocedural events and follow-up outcomes between the two groups were compared. RESULTS There were 32 cases in each group after PSM. Technical success (<50% residual stenosis) was achieved in 30 cases (93.8%) in the DCB group and in 28 cases (87.5%) in the CB group. The rates of stroke or mortality within 30 days were 3.1% in the DCB group and 6.3% in the CB group (p=1). The incidence of restenosis in the DCB group (6.3%) was significantly lower than that in the CB group (31.3%) (p=0.01). CONCLUSIONS Compared with CB angioplasty, DCB angioplasty can effectively reduce the incidence of restenosis. Further studies are needed to validate the role of DCB angioplasty in the management of symptomatic ICAS.
Collapse
Affiliation(s)
- Yao Tang
- Cerebrovascular and Neurosurgery Department of Stroke Center, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Tianxiao Li
- Cerebrovascular and Neurosurgery Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital; Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, Henan, China
| | - Wenbo Liu
- Cerebrovascular and Neurosurgery Department of Stroke Center, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Yanyan He
- Cerebrovascular and Neurosurgery Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital; Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, Henan, China
| | - Liangfu Zhu
- Cerebrovascular and Neurosurgery Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital; Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, Henan, China
| | - Zi-Liang Wang
- Cerebrovascular and Neurosurgery Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital; Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, Henan, China
| | - Yingkun He
- Cerebrovascular and Neurosurgery Department of Interventional Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital; Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, Henan, China
| |
Collapse
|
5
|
Wu CH, Lin TM, Chung CP, Yu KW, Tai WA, Luo CB, Lirng JF, Chang FC. Prevention of in-stent restenosis with drug-eluting balloons in patients with postirradiated carotid stenosis accepting percutaneous angioplasty and stenting. J Neurointerv Surg 2023; 16:73-80. [PMID: 36914246 PMCID: PMC10804009 DOI: 10.1136/jnis-2022-019957] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To investigate the technical safety and outcome of in-stent restenosis (ISR) prevention with drug-eluting balloon (DEB) in patients with postirradiated carotid stenosis (PIRCS) undergoing percutaneous angioplasty and stenting (PTAS). METHODS Between 2017 and 2021, we prospectively recruited patients with severe PIRCS for PTAS. They were randomly separated into two groups based on endovascular techniques performed with and without DEB. Preprocedural and early postprocedural (within 24 hours) MRI, short-term ultrasonography (6 months after PTAS), and long-term CT angiography (CTA)/MR angiography (MRA), 12 months after PTAS, were performed. Technical safety was evaluated based on periprocedural neurological complications and the number of recent embolic ischemic lesions (REIL) in the treated brain territory on diffusion-weighted imaging of early postprocedural MRI. RESULTS Sixty-six (30 with and 36 without DEB) subjects were enrolled, with one failure in techniques. For 65 patients in the DEB versus conventional groups, technical neurological symptoms within 1 month (1/29 (3.4%) vs 0/36; P=0.197) and REIL numbers within 24 hours (1.0±2.1 vs 1.3±1.5; P=0.592) after PTAS showed no differences. Peak systolic velocity (PSVs) on short-term ultrasonography was significantly higher in the conventional group (104.13±42.76 vs .81.95±31.35; P=0.023). The degree of in-stent stenosis (45.93±20.86 vs 26.58±8.75; P<0.001) was higher, and there were more subjects (n=8, 38.9% vs 1, 3.4%; P=0.029) with significant ISR (≥ 50%) in the conventional group than in the DEB group on long-term CTA/MRA. CONCLUSIONS We observed similar technical safety of carotid PTAS with and without DEBs. The number of cases of significant ISR were fewer and the degree of stenosis of ISR was less in primary DEB-PTAS of PIRCS than for conventional PTAS in the 12-month follow-up.
Collapse
Affiliation(s)
- Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Te-Ming Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Ping Chung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kai-Wei Yu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-An Tai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, National Defense Medical Center, Taipei, Taiwan
- Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Qiao H, Chang CH, Wang AYC, Li S, Yang W, Li G, Cen X, Wang R, Lin H. Safety and efficacy of drug coated balloon angioplasty for intracranial atherosclerotic disease. J Neurointerv Surg 2023; 15:e172-e177. [PMID: 36171100 DOI: 10.1136/jnis-2022-019122] [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: 06/02/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Drug coated balloon (DCB) angioplasty can provide sustained anti-restenotic efficacy without the limitations of permanent vascular implantation and is presumably ideal for treating intracranial atherosclerotic disease. However, the safety of paclitaxel in the neurovasculature remains a concern. METHODS 242 patients with angiographically verified symptomatic stenosis >70% in intracranial arteries treated with DCB angioplasty were reviewed divided into two groups: group A, patients with stenotic intracranial arteries; and group B, patients with acute, subacute, or chronic occluded intracranial arteries. The primary endpoint was any stroke or death within 30 days. The secondary endpoint was arterial restenosis of >50% during follow-up. RESULTS 16 major and 12 minor complications occurred among 245 procedures (6.5% and 4.9%, respectively). Five patients died within 30 days after the procedure (2.1%, 5/242). 12 major and 12 minor complications occurred among 211 procedures in group A (5.7% and 5.7%). In group B, four major complications occurred among 34 procedures (11.8%). Hyperperfusion and perforator stroke accounted for half of all complications (53.6%, 15/28). Restenosis >50% was present in eight lesions during the follow-up period (4.8%, 8/167). CONCLUSIONS After treatment with DCB angioplasty, complications were no different from those after standard balloon angioplasty or stenting. This study suggests that DCB angioplasty may be a safe and effective procedure for intracranial arterial stenosis.
Collapse
Affiliation(s)
- Hanzi Qiao
- Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Chien-Hung Chang
- Neurology, Chang Gung Memorial Hospital Linkou Branch, Gueishan, Taoyuan, Taiwan
| | - Alvin Yi-Chou Wang
- Department of Neurosurgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Shaoxue Li
- Neurosurgical Department, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Weilin Yang
- Brain Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Guoming Li
- Neurology Department, Second Clinical Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuecheng Cen
- Neurosurgical Department, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Rongfei Wang
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Lin
- Neurological Department, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| |
Collapse
|
8
|
Ding Q, Liu W, Zhao J, Guo D, Tang Y, Zhou T, He Y, Hui FK, Ding Y, Zhu L, Wang Z, He Y, Li T. A novel cerebrovascular drug-coated balloon catheter for treating symptomatic intracranial atherosclerotic stenosis lesions: Study protocol for a prospective, multicenter, single-arm, target-value clinical trial. J Interv Med 2023; 6:180-186. [PMID: 38312132 PMCID: PMC10831368 DOI: 10.1016/j.jimed.2023.10.001] [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: 08/06/2023] [Revised: 10/01/2023] [Accepted: 10/07/2023] [Indexed: 02/06/2024] Open
Abstract
Background Previous single-center studies have demonstrated that drug-coated balloons (DCBs) may reduce restenosis rates, which is an important factor affecting the prognosis for intracranial interventional therapy. However, currently available cardiac DCBs are not always suitable for the treatment of intracranial atherosclerotic stenosis (ICAS). This study aimed to evaluate the safety and efficacy of a novel DCB catheter designed for patients with severely symptomatic ICAS. Methods This prospective, multicenter, single-arm, target-value clinical trial was conducted in 9 Chinese stroke centers to evaluate the safety and efficacy of a novel DCB catheter for treating symptomatic severe ICAS. Primary metrics and other indicators were collected and analyzed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results A total of 155 patients were enrolled in this study. The preliminary collection of follow-up data has been completed, while data quality control is ongoing. Conclusion Results of this study demonstrated the patency rate, safety, and effectiveness of a novel on-label paclitaxel DCB designed for the treatment of ICAS. Trial registration ChiCTR, ChiCTR2100047223. Registered June 11, 2021-Prospective registration, https://www.chictr.org.cn/ChiCTR2100047223.
Collapse
Affiliation(s)
- Qianhao Ding
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, 450003, China
| | - Wenbo Liu
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, 450003, China
| | - Jingge Zhao
- Clinical Research Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - Dehua Guo
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, 450003, China
| | - Yao Tang
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, 450003, China
| | - Tengfei Zhou
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, 450003, China
| | - Yanyan He
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, 450003, China
| | - Ferdinand K. Hui
- Neuroscience Institute, Queen's Medical Center, University of Hawaii, Honolulu, HI, USA
| | - Yonghong Ding
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Liangfu Zhu
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, 450003, China
| | - Zilang Wang
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, 450003, China
| | - Yingkun He
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, 450003, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease and Henan Engineering Research Center of Cerebrovascular Intervention, Zhengzhou, 450003, China
| |
Collapse
|
9
|
Li X, Qin X, Liu C, Zhu L, Wang M, Jiang T, Liu Y, Li S, Shi H, Sun H, Deng Q, Zhou J. Percutaneous angioplasty and/or stenting versus aggressive medical therapy in patients with symptomatic intracranial atherosclerotic stenosis: a 1-year follow-up study. Front Aging Neurosci 2023; 15:1192681. [PMID: 37396661 PMCID: PMC10313453 DOI: 10.3389/fnagi.2023.1192681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Background Symptomatic intracranial atherosclerotic stenosis (sICAS) is one of the common causes of ischemic stroke. However, the treatment of sICAS remains a challenge in the past with unfavorable findings. The purpose of this study was to explore the effect of stenting versus aggressive medical management on preventing recurrent stroke in patients with sICAS. Methods We prospectively collected the clinical information of patients with sICAS who underwent percutaneous angioplasty and/or stenting (PTAS) or aggressive medical therapy from March 2020 to February 2022. Propensity score matching (PSM) was employed to ensure well-balanced characteristics of two groups. The primary outcome endpoint was defined as recurrent stroke or transient ischemic attack (TIA) within 1 year. Results We enrolled 207 patients (51 in the PTAS and 156 in the aggressive medical groups) with sICAS. No significant difference was found between PTAS group and aggressive medical group for the risk of stroke or TIA in the same territory beyond 30 days through 6 months (P = 0.570) and beyond 30 days through 1 year (P = 0.739) except for within 30 days (P = 0.003). Furthermore, none showed a significant difference for disabling stroke, death and intracranial hemorrhage within 1 year. These results remain stable after adjustment. After PSM, all the outcomes have no significant difference between these two groups. Conclusion The PTAS has similar treatment outcomes compared with aggressive medical therapy in patients with sICAS across 1-year follow-up.
Collapse
Affiliation(s)
- Xiaohui Li
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaodan Qin
- General Clinical Research Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chengfang Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lin Zhu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Meng Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yukai Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shuo Li
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hongchao Shi
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiling Sun
- General Clinical Research Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qiwen Deng
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
10
|
Huang J, Jiao S, Chen Y, Lu J, Song Y, Zhang J, Zhang C, Liu C, Gong T, Wang D, Zhu J, Chen M. Efficacy of medical treatment and balloon angioplasty for severe intracranial atherosclerosis: a high-resolution MR vessel wall imaging. Eur Radiol 2023; 33:2478-2488. [PMID: 36418621 DOI: 10.1007/s00330-022-09218-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/27/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the efficacy of medical treatment and balloon angioplasty for intracranial atherosclerosis using high-resolution MR vessel wall imaging (HR-MRI). METHODS In this prospective study, patients with symptomatic severe stenosis from January 2018 to August 2021 were treated with medical treatment or balloon angioplasty. The patients underwent HR-MRI at baseline and at 3, 6, and 12 months. Plaque characteristics at follow-up were compared with those at baseline using paired sample T-test or Wilcoxon rank sum test. The difference in the recurrence of ischemic events between two groups was compared. RESULTS A total of 37 patients (26 males; mean age = 60.5 ± 11.6 years) were evaluated. Of 68 plaques, 42 (61.8%) were treated with medication only. At 12 months of medical treatment, maximum plaque length (p = 0.004), maximum wall thickness (p = 0.036), and plaque enhancement (p = 0.001) were significantly reduced than baseline. At 3 months after balloon angioplasty, luminal stenosis (p = 0.048) was significantly reduced compared to baseline. At 6 months after balloon angioplasty, maximum plaque length (p = 0.011), maximum wall thickness (p = 0.003), and luminal stenosis (p = 0.001) were significantly reduced than baseline. No difference was found in the recurrence of ischemic events between two groups (p = 0.458). CONCLUSION Intracranial atherosclerotic plaque shrank and tended to be stable at 12 months of medical treatment. Plaque burden was significantly reduced 6 months after balloon angioplasty. This may provide evidence for the application and selection of treatment strategies for intracranial atherosclerotic disease. KEY POINTS • Plaque burden and plaque enhancement were significantly reduced at 12 months of medical treatment compared to baseline. • Plaque burden was significantly reduced at 6 months after balloon angioplasty compared with baseline. • No significant difference in the recurrence rate of ischemic stroke between patients treated with medication and balloon angioplasty.
Collapse
Affiliation(s)
- Juan Huang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| | - Sheng Jiao
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| | - Yuhui Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China.
| | - Jintao Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| | - Chen Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| | - Cong Liu
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| | - Tao Gong
- Department of Neurology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 Dahua Road, Dong Dan, Beijing, 100730, China
| |
Collapse
|
11
|
Medical and Endovascular Treatments for Intracranial Atherosclerotic Stenosis: A Network Meta-Analysis. Transl Stroke Res 2023; 14:83-93. [PMID: 34792778 DOI: 10.1007/s12975-021-00957-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 01/31/2023]
Abstract
Medical treatment and endovascular therapy are widely used for intracranial atherosclerotic stenosis, but the best treatment strategy remains uncertain. The goal of this study was to compare the safety and effectiveness of medical treatment, stenting, and primary balloon angioplasty (PBA). We searched PubMed, MEDLINE, and EMBASE for trials comparing these three treatments for intracranial stenosis up to December 24, 2020. We performed a network meta-analysis with random-effects models. The primary outcome was any stroke or death during a long-term follow-up. Secondary outcomes included ischemic stroke, intracranial hemorrhage, and death. This network meta-analysis included 14 trials with 1520 participants. No significant difference was found between the three groups in the primary outcome, while PBA was probably the best treatment according to the ranking plot. Medical treatment had significantly lower rate of any stroke or death (odds ratio (OR), 0.31; 95% CI, 0.17-0.56), ischemic stroke (OR, 0.43; 95% CI, 0.23-0.81), and intracranial hemorrhage (OR, 0.12; 95% CI, 0.02-0.71) within 30 days than stenting but did not differ from PBA. The ranking plot demonstrated that PBA was also most likely to rank the highest for ischemic stroke during the long-term follow-up and beyond 30 days, although no significant difference was identified. Medical treatment had lower risk of any stroke or death within 30 days than stenting but did not differ from PBA. All the treatments had similar effects on the prevention of long-term stroke, while PBA had the highest probability of being the most effective.
Collapse
|
12
|
Ueda T, Takaishi S, Yoshie T, Usuki N, Tatsuno K, Ohtsubo H, Araga T, Kaga Y, Takada T. Long-term outcome and factors associated with restenosis after combination therapy of balloon angioplasty and stenting for symptomatic intracranial stenosis. BMC Neurol 2022; 22:477. [PMID: 36510182 PMCID: PMC9746162 DOI: 10.1186/s12883-022-03009-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/03/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The optimal treatment for intracranial artery stenosis (ICAS) has not been established. We retrospectively examined the initial and long-term outcomes associated with restenosis of a combination therapy of balloon angioplasty and stenting for symptomatic atherosclerotic ICAS. METHODS Consecutive patients who underwent balloon angioplasty and/or stenting for ≥ 70% ICAS between 2006 and 2020 were analyzed. Patients within 48 h of stroke onset were excluded. The following procedures were established as standards at our institution: (1) primary balloon angioplasty alone was initially performed; (2) stenting for insufficient dilatation, recoiling, or dissection was conducted; and (3) stenting was considered for restenosis. Intracranial ischemic and hemorrhagic complications within 30 days after treatment were used to evaluate periprocedural safety. Recurrent ischemic events, restenosis and restenosis related factors were used to be evaluate the long-term outcome. RESULTS A total of 160 patients were recruited. Initial treatment consisted of balloon angioplasty (n = 101) and stenting (n = 59). Intracranial complications within 30 days after treatment were ischemic in five (3.1%) and hemorrhagic in four patients (2.5%). The incidence of these complication was 3.1% in the stenting group and 2.5% in the balloon angioplasty group. The mean follow-up period was 53.9 months. Restenosis was found in 42 patients (26%). Recurrent ischemic events during follow-up were noted in 14 patients (8.8%), of which six patients had TIA and eight patients had ischemic stroke. Restenosis-associated factors included diabetes, coronary artery disease, percent stenosis after treatment, and balloon angioplasty in logistic univariate analysis. Multivariate Cox regression analysis showed that diabetes (HR: 2.084, CI: 1.039-4.180, p = 0.0386), length of lesion (HR; 1.358, CI: 1.174-1.571, p < 0.0001), and balloon angioplasty (HR: 4.194, CI: 1.083-16.239, p = 0.0379) were independent predictors for restenosis. CONCLUSION Combination therapy of balloon angioplasty and stenting for symptomatic ICAS had a low perioperative stroke rate and may improve long-term outcome. Balloon angioplasty, diabetes, and length of lesion were significantly associated with restenosis.
Collapse
Affiliation(s)
- Toshihiro Ueda
- grid.412764.20000 0004 0372 3116Department of Strokology and Neuroendovascular Treatment, Stroke Center, St. Marianna University Toyoko Hospital, Kosugi 3-435, Nakahara, Kawasaki, 211-0063 Japan
| | - Satoshi Takaishi
- grid.412764.20000 0004 0372 3116Department of Strokology and Neuroendovascular Treatment, Stroke Center, St. Marianna University Toyoko Hospital, Kosugi 3-435, Nakahara, Kawasaki, 211-0063 Japan
| | - Tomohide Yoshie
- grid.412764.20000 0004 0372 3116Department of Strokology and Neuroendovascular Treatment, Stroke Center, St. Marianna University Toyoko Hospital, Kosugi 3-435, Nakahara, Kawasaki, 211-0063 Japan
| | - Noriko Usuki
- grid.412764.20000 0004 0372 3116Department of Strokology and Neuroendovascular Treatment, Stroke Center, St. Marianna University Toyoko Hospital, Kosugi 3-435, Nakahara, Kawasaki, 211-0063 Japan
| | - Kentaro Tatsuno
- grid.412764.20000 0004 0372 3116Department of Strokology and Neuroendovascular Treatment, Stroke Center, St. Marianna University Toyoko Hospital, Kosugi 3-435, Nakahara, Kawasaki, 211-0063 Japan
| | - Haruki Ohtsubo
- grid.412764.20000 0004 0372 3116Department of Strokology and Neuroendovascular Treatment, Stroke Center, St. Marianna University Toyoko Hospital, Kosugi 3-435, Nakahara, Kawasaki, 211-0063 Japan
| | - Takashi Araga
- grid.412764.20000 0004 0372 3116Department of Strokology and Neuroendovascular Treatment, Stroke Center, St. Marianna University Toyoko Hospital, Kosugi 3-435, Nakahara, Kawasaki, 211-0063 Japan
| | - Yasuyuki Kaga
- grid.412764.20000 0004 0372 3116Department of Practical Management of Medical Information, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tatsuro Takada
- grid.412764.20000 0004 0372 3116Department of Strokology and Neuroendovascular Treatment, Stroke Center, St. Marianna University Toyoko Hospital, Kosugi 3-435, Nakahara, Kawasaki, 211-0063 Japan
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Yang B, Kang K, Gao F, Mo D, Tong X, Song L, Sun X, Liu L, Huo X, Miao Z, Ma N. Association of occlusion time with successful endovascular recanalization in patients with symptomatic chronic intracranial total occlusion. J Neurosurg 2022; 137:1095-1104. [PMID: 35120327 DOI: 10.3171/2021.12.jns212337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endovascular treatment is one of the choices for symptomatic chronic intracranial total occlusion (CITO); however, its safety and efficacy remain unclear. The present study was performed to evaluate the safety and long-term outcome of endovascular treatment for CITO at a high-volume stroke center. METHODS Data about patients with symptomatic CITO who received endovascular treatment were retrospectively collected. Technique success was regarded as ≤ 30% residual stenosis. Periprocedural complications within 30 days were used to evaluate safety. Baseline characteristics and lesion features were compared between patients with successful recanalization and those with recanalization failure. Stroke recurrence and in-stent restenosis (ISR) of the culprit arteries during follow-up were used to evaluate long-term efficacy. RESULTS From June 2012 to September 2019, 117 patients (mean ± SD age 55.8 ± 9.6 years) were included. The successful recanalization rate was 82.9% (97/117 patients). The combined rate of periprocedural stroke, myocardial infarction, and death was 8.5% (10/117). Compared with patients with successful recanalization, patients with recanalization failure had longer occlusion time and longer lesion length (27.0 mm vs 15.4 mm, p = 0.001). In the median 23.0-month clinical follow-up period, recurrent stroke occurred in 12.6% (11/87) of patients with successful recanalization. In the median 5-month imaging follow-up period, ISR was detected in 26.6% (21/79) of patients. CONCLUSIONS Endovascular treatment was relatively safe for patients with symptomatic CITO. Shorter occlusion time and shorter lesion length may be associated with higher recanalization rate. The rates of stroke recurrence and symptomatic ISR were acceptable but need to be confirmed in future studies.
Collapse
Affiliation(s)
- Bo Yang
- 1Department of Neurology, Beijing Jiangong Hospital, Beijing, China
- 3Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Kaijiang Kang
- 2Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Feng Gao
- 3Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Dapeng Mo
- 3Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xu Tong
- 3Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ligang Song
- 3Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xuan Sun
- 3Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Lian Liu
- 3Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiaochuan Huo
- 3Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhongrong Miao
- 3Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ning Ma
- 3Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 4China National Clinical Research Center for Neurological Diseases, Beijing, China; and
- 5Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| |
Collapse
|
15
|
Yin H, Zhang J, Zhao W, Zheng M, Song Y, Sun L, Zhang J, Han J. Drug-Coated Balloon for the Treatment of Nonacute Symptomatic Intracranial Carotid Artery Terminus Occlusion: Initial Experience and Follow-Up Outcome. Front Neurol 2022; 13:840865. [PMID: 35222260 PMCID: PMC8879511 DOI: 10.3389/fneur.2022.840865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStudies on the recanalization for occlusion of the internal carotid artery terminus are scattered. Recently, drug-coated balloon (DCB) has been increasingly applied in the intracranial artery occlusion and achieved encouraging results. However, there seems no convincing data for the nonacute symptomatic internal carotid artery terminus occlusion (sICATO).ObjectiveTo assess the feasibility and effectiveness (safety) of DCB for patients with nonacute sICATO refractory to medical therapy.ApproachThis study included 30 patients with nonacute sICATO treated with DCBs and/or remedial stenting. The rate of successful recanalization, periprocedural complications, and clinical and vascular imaging follow-up outcomes were retrospectively analyzed.ResultsDrug-coated balloon (DCB) dilatation of nonacute sICATO gives a 100% rate of successful recanalization, with a low complication rate (10.00%), good clinical outcomes (86.20%), low restenosis/reocclusion rate (3.45%), and one asymptomatic ipsilateral infarction (3.45%).ConclusionDrug-coated balloon dilation seems to be the promising treatment option for nonacute sICATO considering its safety and feasibility.
Collapse
|
16
|
Zhang Y, Chu X, Meng Y, Zhang J, Sun L, Zhao W, Zheng M, Yin H, Wang W, Zhang J, Song Y, Han J. Drug-Coated Balloon-Oriented Angioplasty for Severe Symptomatic Atherosclerotic MCA Stenosis in Young Adults. Front Neurol 2022; 12:743851. [PMID: 35178020 PMCID: PMC8844447 DOI: 10.3389/fneur.2021.743851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/02/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose The clinical significance of endovascular therapy in young patients with symptomatic intracranial atherosclerotic stenosis is not clear. We aimed to report our preliminary findings on the safety and effectiveness of a new endovascular treatment strategy, drug-coated balloon (DCB)-oriented angioplasty for young adults with severe symptomatic atherosclerotic middle cerebral artery (MCA) stenosis. Methods We retrospectively retrieved the data of seven young patients aged 21–32 years old with severe symptomatic atherosclerotic MCA stenosis treated with DCB-oriented angioplasty from January 2018 to October 2020. We collected clinical presentations, perioperative complications, and clinical and radiological outcomes. Results The DCB was successfully dilated at the lesions in all seven patients and good antegrade perfusion was achieved in five. The other two patients underwent remedial stent implantation due to residual stenosis >50% and unstable antegrade perfusion after DCB dilatation. However, none of the patients had perioperative complications. There were no recurrent ischemic symptoms after a mean clinical follow-up period of 15.4 ± 6.9 months. Repeat vascular images of the patients showed no restenosis at 3- or 6-month imaging follow-up periods. High-resolution MRI (HRMRI) was completed in all the patients before the angioplasty procedure and at follow-up. Focal eccentric wall thickening was present at the site of stenosis preoperatively; however, the plaques had disappeared by the time of follow-up for all patients. Conclusion DCB-oriented angioplasty may be safe and effective for young patients with severe symptomatic atherosclerotic MCA stenosis.
Collapse
|
17
|
Wang J, Zhang S, Lu J, Qi P, Hu S, Yang X, Chen K, Wang D. High-Resolution MR for Follow-Up of Intracranial Steno-Occlusive Disease Treated by Endovascular Treatment. Front Neurol 2022; 12:706645. [PMID: 35002907 PMCID: PMC8740140 DOI: 10.3389/fneur.2021.706645] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: An endovascular recanalization is an alternative option for symptomatic intracranial atherosclerotic steno-occlusive disease (ICAD). Accurate non-invasive alternatives to digital subtraction angiography (DSA) for follow-up imaging after endovascular treatment are desirable. We aimed to evaluate the image quality and diagnostic performance of high-resolution magnetic imaging in follow-up using DSA as a reference. Materials and Methods: From January 2017 to June 2021, data from 35 patients with 40 intracranial steno-occlusive lesions who underwent endovascular recanalization and received high-resolution magnetic resonance (HR-MR) follow-up were retrospectively collected in our prospective database. Studies were evaluated for the quality of visualization of the vessel lumen, restenosis rate, and accuracy of high-resolution magnetic resonance (HR-MR) with DSA used as the reference standard. Intraclass correlation coefficient (ICC) analyses were performed to assess the agreement between the two different readers. Results: In total, 40 intracranial steno-occlusive lesions in 35 patients, with 34 lesions undergoing balloon angioplasty [including 16 drug-coated balloons (DCBs)] and 8 lesions undergoing stenting were enrolled. The median age was 63.6 years (IQR 58.5-70.0 years), and the mean imaging follow-up time was 9.5 months (IQR 4.8-12.5 months). The median degrees of preprocedural and residual stenosis were 85.0% (IQR 75.0-99.0%) and 32.8% (IQR 15.0-50.0%), respectively. Intracranial periprocedural complications occurred in 1 (3.6%) patient. In the case of a stainless-steel stent (n = 1), there was a signal drop at the level of the vessel, which did not allow evaluation of the vessel lumen. However, this was visible in the case of nitinol stents (n = 7) and angioplasty (n = 34). The overall restenosis rate was 25.8% (n = 9). The DCB subgroup showed a lower rate of restenosis than the percutaneous transluminal angioplasty (PTA) subgroup [5.3% (2/13) vs. 35.7% (5/14)]. Conclusion: High-resolution magnetic resonance may be a reliable non-invasive method for demonstrating the vessel lumen and diagnostic follow-up after endovascular recanalization for ICAD. Compared with MR angiography (MRA), HR-MR showed a higher inter-reader agreement and could provide more information after endovascular recanalization, such as enhancement of the vessel wall.
Collapse
Affiliation(s)
- Junjie Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shun Zhang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shen Hu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ximeng Yang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Kunpeng Chen
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
Endovascular therapy of symptomatic high-grade stenosis of left internal carotid artery in C6 segment using Elutax "3" Neuro pDEB. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:332-333. [PMID: 34819977 PMCID: PMC8596724 DOI: 10.5114/aic.2021.109162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/07/2021] [Indexed: 11/17/2022] Open
|
20
|
Gruber P, Singh S, Andereggen L, Berberat J, Remonda L. Drug-Coated Balloons for the Treatment of Symptomatic Intracranial High-Grade Stenosis: A Review of the Current Rationale. Front Neurol 2021; 12:692208. [PMID: 34385971 PMCID: PMC8353086 DOI: 10.3389/fneur.2021.692208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Symptomatic intracranial atherosclerotic disease (sICAD) remains a challenging disorder in the neurovascular field. Despite best medical treatment, the recurrence rate for stroke remains high in patients with intracranial high-grade stenosis (>70–99%). Furthermore, two large randomized trials (SAMMPRIS and VISSIT) failed to prove the efficacy of percutaneous transluminal angioplasty and stenting in patients with sICAD. Drug-coated balloon percutaneous transluminal angioplasty (DCB-PTA) represents an alternative treatment modality with therapeutic benefits for interventional cardiology. However, there are very few articles in the existing literature that relate to the use of DCB-PTA in sICAD patients. Here, we aimed to review the rationale underlying the use of DCB-PTA in sICAD patients and summarize recent developments in the neurovascular field.
Collapse
Affiliation(s)
- Philipp Gruber
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Samarth Singh
- Department of Neurology, Norvic International Hospital, Kathmandu, Nepal
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.,Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Jatta Berberat
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Remonda
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland.,Faculty of Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Zhang J, Zhang X, Zhang J, Song Y, Zheng M, Sun L, Meng Y, Zhao W, Yin H, Wang W, Han J. Drug-Coated Balloon Dilation Compared With Conventional Stenting Angioplasty for Intracranial Atherosclerotic Disease. Neurosurgery 2021; 87:992-998. [PMID: 32445576 DOI: 10.1093/neuros/nyaa191] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/18/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Conventional stent-based angioplasty was challenged for the high incidence of perioperative complications and follow-up in-stent restenosis (ISR) in treating intracranial atherosclerotic disease (ICAD). Currently, the drug-coated balloon (DCB) has shown promise in preventing and treating ISR. OBJECTIVE To compare the efficacy and safety of DCB dilation (with or without stenting) with conventionally only stenting angioplasty for symptomatic ICAD in routine clinical practice. METHODS From January 2016 to January 2019, consecutive patients treated with endovascular therapy for symptomatic ICAD were identified and dichotomized by whether DCB was used. The efficacy and safety endpoints, including periprocedural complications, clinical, and imaging follow-up outcomes between the 2 groups, were compared by propensity score matching. RESULTS A total of 42 patients in the DCB group and 73 patients in the non-DCB group were enrolled. Propensity score matching analysis selected 76 matched patients. Angiographic follow-up was completed at 185 ± 33 d. The median stenosis degree (0 [0%-20.0%] vs 15.0 [0%-62.5%], P = .005) and total restenosis incidence (5.3% [2/38] vs 34.2% [13/38], P = .003) in the DCB group were significantly lower than those in the non-DCB group. The periprocedural complications (2.6% vs 10.5%, P = .375), recurrent ischemic events (2.6% vs 13.2%, P = .219), and symptomatic restenosis (2.6% vs 10.5%, P = .375) were not statistically different between the 2 groups. CONCLUSION Compared with conventionally only stenting angioplasty, DCB dilation can effectively lower restenosis degree and total restenosis risk, with no superiority in symptomatic restenosis at 6-mo follow-up.
Collapse
Affiliation(s)
- Jun Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Xiao Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jinping Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yun Song
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Meimei Zheng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Lili Sun
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yao Meng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Wei Zhao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Hao Yin
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Wei Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Ju Han
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| |
Collapse
|
23
|
Guo X, Ma N, Gao F, Mo DP, Luo G, Miao ZR. Long-Term Risk Factors for Intracranial In-Stent Restenosis From a Multicenter Trial of Stenting for Symptomatic Intracranial Artery Stenosis Registry in China. Front Neurol 2021; 11:601199. [PMID: 33574792 PMCID: PMC7871004 DOI: 10.3389/fneur.2020.601199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background: For patients with symptomatic intracranial artery stenosis (sICAS), endovascular treatment has been shown to be feasible and safe in recent studies. However, in-stent restenosis (ISR) risks the recurrence of ischemic stroke. We attempt to elucidate the risk factors for ISR. Methods: We retrospectively analyzed 97 patients with sICAS from a prospective registry trial that included 20 centers from September 2013 to January 2015. Cases were classified into the ISR≥ 50% group or the ISR < 50% group. The baseline characteristics and long-term follow-up were compared between the two groups. Binary logistic regression analyses were identified as an association between ISR and endovascular technique factors. Results: According to whether ISR was detected by CT angiography, 97 patients were divided into the ISR group (n = 24) and the non-ISR group (n = 73). The admission baseline features and lesion angiography characteristics were similar, while plasma hs-CRP (mg/L) was higher in the ISR≥ 50% group at admission (8.2 ± 11.4 vs. 2.8 ± 4.1, p = 0.032). Binary logistic regression analysis identified the longer stents (adjusted OR 0.816, 95% CI 0.699-0.953; p = 0.010), balloon-mounted stents (adjusted OR 5.748, 95% CI 1.533-21.546; p = 0.009), and local anesthesia (adjusted OR 6.000, 95% CI 1.693-21.262; p = 0.006) as predictors of ISR at the 1-year follow-up. Conclusions: The longer stents, balloon-mounted stents implanted in the intracranial vertebral or basilar artery, and local anesthesia were significantly associated with in-stent restenosis. Further studies are required to identify accurate biomarkers or image markers associated with ISR in ICAS patients. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01968122.
Collapse
Affiliation(s)
- Xu Guo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 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
| | - Da-Peng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gang Luo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhong-Rong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
24
|
Abstract
Disease of the vertebral (VA) and basilar arteries (BA) can lead to stroke of the posterior circulation and may warrant management strategies which differ from the anterior circulation. The mechanism and location of the disease determine its natural history and therefore affect the relative risks and benefits of the possible treatment options. Vertebrobasilar (VB) atherosclerotic disease is a source of both hemodynamic and embolic posterior circulation stroke. Advances in medical therapy have decreased the rate of stroke after initial symptomatic presentation. Antiplatelet therapy, blood pressure control, and optimization of secondary risk factors can reduce recurrent stroke risk in both intracranial and extracranial VB disease. However, symptomatic intracranial disease is still associated with a high risk of subsequent stroke, particularly those with hemodynamic compromise who represent a higher risk population. Patients with hemodynamic impairment may benefit from judicious application of endovascular and microsurgical interventions to augment blood flow. Stenting, angioplasty alone, bypass surgery, and endarterectomy, represent endovascular and surgical tools available to address medically refractory VB disease. Apart from atherosclerotic disease, dissection is another etiology of VB stroke, most frequently affecting the extracranial VA. Treatment is predominantly antithrombotic therapy although surgical or endovascular intervention can be required in rare cases of persistent embolism or hemodynamic compromise. In contrast, extrinsic compromise of the VA represents a separate extracranial pathology and is best treated with mechanistically targeted surgeries or extracranial bypass.
Collapse
Affiliation(s)
- Richard Bram
- Department of Neurosurgery, Neuropsychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA
| | - Alfred P See
- Department of Neurosurgery, Neuropsychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, Neuropsychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA -
| |
Collapse
|
25
|
Serrano Serrano B, Hernández Fernández F, López Hernández N, Elvira Soler E, Barbieri G, Molina Nuevo JD. Treatment of acute occlusion due to intracranial atherosclerosis by angioplasty with ELUTAX “3″ drug-eluting balloon. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
26
|
Shao Q, Li Q, Wu Q, Li T, Li L, Chang K. Comparison of 3D T1-SPACE and DSA in evaluation of intracranial in-stent restenosis. Br J Radiol 2020; 94:20190950. [PMID: 33259233 DOI: 10.1259/bjr.20190950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In-stent restenosis (ISR) after stenting for intracranial stenosis is a significant issue. This study aimed to evaluate the usefulness of the 3D T1-SPACE technique in the follow-up of patients after stent implantation. METHODS Fifteen patients with intracranial arterial stenosis were prospectively enrolled 6-8 months after stenting. Digital subtraction angiography (DSA) and 3D T1-SPACE imaging were performed to evaluate the degree of stenosis and the enhancement of the vessel wall. Bland-Altman plots were used to assess the agreement between the two imaging methods, and the Pearson correlation coefficient was calculated as a measure of the linear correlation. RESULTS Eight Enterprise stents and seven Wingspan stents were used in 15 patients. The follow-up DSA after 6-8 months showed that the degree of stenosis was 40% (range, 30-72%), and ISR occurred in 4 of 15 (26.7%) lesions. The degree of stenosis assessed using the 3D T1-SPACE imaging technique was 35% (range, 30-75%). All four patients with ISR demonstrated significant enhancement. The Pearson correlation coefficient between the two methods was 0.959 (p < 0.05), and the Bland-Altman plot showed that all data points were within the consistency limits ([Formula: see text] ± 1.96 s). CONCLUSION As a non-invasive imaging modality, 3D T1-SPACE showed great consistency with DSA in measuring the degree of stenosis after intracranial stenting. It may be used as an optional method for detecting ISR. ADVANCES IN KNOWLEDGE This study evaluated the usefulness of 3D T1-SPACE technique in the follow-up of patients after stent implantation, which could be used as an optional and non-invasive method in detection of in-stent restenosis.
Collapse
Affiliation(s)
- Qiuji Shao
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Qiang Li
- Department of Radiology, Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Qiaowei Wu
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Li Li
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Kaitao Chang
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan University People's Hospital, Zhengzhou, China
| |
Collapse
|
27
|
Xu H, Fu X, Yuan Y, Quan T, Wang Z, Han K, Liu G, Guan S. Feasibility and Safety of Paclitaxel-Coated Balloon Angioplasty for the Treatment of Intracranial Symptomatic In-Stent Restenosis. Front Neurol 2020; 11:774. [PMID: 32849227 PMCID: PMC7431892 DOI: 10.3389/fneur.2020.00774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Symptomatic in-stent restenosis (sISR) is the major cause of medium- or long-term cerebral infarctions in patients who underwent percutaneous transluminal angioplasty and stenting for severe intracranial atherosclerotic stenosis. This study aims to evaluate the feasibility and safety of paclitaxel-coated balloon (PCB) angioplasty for the treatment of intracranial sISR. Methods: We report 11 cases of PCB angioplasty for intracranial sISR. Lesion locations and number were as follows: intracranial internal carotid artery (n = 4), M1 segment of middle cerebral artery (MCA) (n = 1), V4 segment of vertebral artery (n = 6). The technical success rate, periprocedural complications, and short-term outcome were retrospectively analyzed. Results: All procedures were successfully performed without periprocedural complication. Asymptomatic vessel dissection after PCB inflation occurred in one case. Postprocedural diffusion-weighted imaging (DWI) showed new asymptomatic ipsilateral infarction in one case. All 11 cases did not experience ipsilateral stroke or death within 30 days or ischemic stroke in the territory of the target artery between 31 and 90 days after procedure. Conclusion: This preliminary study indicates that PCB angioplasty is feasible and safe for the treatment of intracranial sISR. Further studies are needed to clarify its efficiency and long-term outcome.
Collapse
Affiliation(s)
- Haowen Xu
- Department of Neurointerventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaojie Fu
- Department of Neurointerventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongjie Yuan
- Department of Neurointerventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tao Quan
- Department of Neurointerventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zibo Wang
- Department of Neurointerventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kaihao Han
- Department of Neurointerventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guo Liu
- Department of Neurointerventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sheng Guan
- Department of Neurointerventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
28
|
Wang AYC, Chang CH, Chen CC, Wu YM, Lin CM, Chen CT, Hsieh PC. Leave Nothing Behind: Treatment of Intracranial Atherosclerotic Disease with Drug-Coated Balloon Angioplasty. Clin Neuroradiol 2020; 31:35-44. [PMID: 32720067 DOI: 10.1007/s00062-020-00935-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Intracranial atherosclerosis disease (ICAD) is an essential cause of stroke. The characteristics of effective treatment include low periprocedural risk and a sustained treatment effect. Angioplasty with a conventional balloon for ICAD is safe but has a dauntingly high restenosis rate. Drug-coated balloon (DCB) angioplasty might reduce the risk of restenosis while maintaining the overall safety of the procedure. METHODS This study included symptomatic ICAD patients with more than 70% stenosis. Intermediate catheters were placed distally, and the lesions were predilated with a conventional balloon, followed by a DCB (SeQuent Please, B Braun, Melsungen, Germany). The primary endpoint was any stroke or death within 30 days or ipsilateral ischemic stroke thereafter. The secondary endpoint was arterial restenosis of more than 50% during follow-up. RESULTS A total of 39 sessions of DCB angioplasty were performed for 39 lesions in 35 patients between October 2015 and April 2018 in a single center. All of the DCBs could be navigated to the lesions. Major periprocedural complications were noted in two patients (5.7%, 2/35), and minor periprocedural complications were also noted in two patients (5.7%, 2/35). The average percentages of stenosis of the lesions were 76.6% ± 7% before treatment, 32.4% ± 11.2% after DCB angioplasty, and 25% ± 16% at follow-up. Stenosis over 50% was present in 3 lesions during the follow-up period (8.3%, 3/36). CONCLUSION In this study, the application of DCBs to treat ICAD patients was feasible and safe. A larger scale clinical trial is warranted to further evaluate the safety and efficacy of this treatment.
Collapse
Affiliation(s)
- Alvin Yi-Chou Wang
- Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, 510120, Guangzhou, Guangdong, China.
| | - Chien-Hung Chang
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Yi-Ming Wu
- Department of Medical imaging and intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Chuan-Min Lin
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Po-Chuan Hsieh
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| |
Collapse
|
29
|
Remonda L, Diepers M, Berberat J, Kahles T, Anon J, Nedeltchev K, Gruber P. Drug-Coated Balloon Treatment in Symptomatic Intracranial High Grade Stenosis : A Retrospective Study of 33 Patients. Clin Neuroradiol 2020; 31:45-49. [PMID: 32691077 DOI: 10.1007/s00062-020-00936-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Endovascular therapy (EVT) represents an alternative treatment modality for symptomatic intracranial high-grade atherosclerotic stenosis (sICAS); however, periprocedural complication rates as well as midterm restenosis rates represent relevant limitations of EVT. Drug-coated balloon percutaneous transluminal angioplasty (DCB-PTA) may overcome some of these shortcomings. The aim of this study was to assess feasibility and safety as well as the stroke recurrence rate in 33 patients. METHODS A retrospective, monocentric cohort study of sICAS patients treated with DCB-PTA. Outcome measures were the periprocedural intracranial complication rate, the recurrent stroke rate and mortality during follow-up. RESULTS This cohort study included 33 patients with 35 sICAS treated with DCB-PTA. The median age was 72 years (interquartile range, IQR 66-77 years); median clinical and mean radiological follow-up time was 9 months (IQR 3-22 months). Median preprocedural degree of stenosis (WASID) was 80% (IQR 73-80%) and median postprocedural residual stenosis degree (WASID) was 50% (IQR 33-60%). Intracranial periprocedural complications occurred in 2 (6%) patients. The overall restenosis rate was 15% (n = 5). In four patients a symptomatic ischemic re-event occurred within 7 months after the initial treatment. None of the patients died. CONCLUSION This DCB-PTA cohort study showed a relatively low intracranial complication rate of 6% with a symptomatic recurrence rate of 12%. Larger trials are needed to validate these promising observations.
Collapse
Affiliation(s)
- Luca Remonda
- Department of Neuroradiology, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.,University Berne, Berne, Switzerland
| | - Michael Diepers
- Department of Neuroradiology, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Jatta Berberat
- Department of Neuroradiology, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Timo Kahles
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Anon
- Department of Neuroradiology, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Krassen Nedeltchev
- University Berne, Berne, Switzerland.,Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Gruber
- Department of Neuroradiology, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| |
Collapse
|
30
|
Elvira Soler E, Serrano Serrano B, López Hernández N, Guevara Dalrymple N, Moliner Castellano S, Gallego León JI. Transcranial duplex ultrasound monitoring of intracranial arterial stenosis treated with ELUTAX "3" drug-eluting balloon. Interv Neuroradiol 2020; 26:800-804. [PMID: 32475193 DOI: 10.1177/1591019920929812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report the results of transcranial ultrasound monitoring in three patients with intracranial arterial stenosis of the middle cerebral artery treated with the only drug-eluting balloon certificated for intracranial use in highly symptomatic intracranial arterial stenosis, ELUTAX "3" (AR Baltic Medical). We performed transcranial Doppler ultrasounds 24 h, 72 h, 10 days, 15 days and 30 days after the angioplasty, thereby measuring mean flow velocity (MFV) in the maximum stenosis area in patients with symptomatic steno-occlusive disease of the middle cerebral artery treated with ELUTAX "3". Two patients were treated during mechanical thrombectomy (MT) due to acute ischemic stroke and one patient was treated on elective basis due to symptomatic pre-occlusive stenosis, with recurrent transient ischemic attacks (TIAs) refractory to medical therapy. In Case 1, the first transcranial Doppler ultrasounds evidenced MFV of 348 cm/s, with progressive MFV reduction until 15 days post-treatment, with MFV of 177 cm/s. In Case 2, 24 h after angioplasty had an MFV of 258 cm/s, decreasing to 103 cm/s at 30 days. Case 3 had an MFV of 436 cm/s before angioplasty that immediately decreased after the procedure to 364 cm/s, with a final MFV of 260 cm/s at 30 days. We have recorded a progressive MFV reduction in intracranial arterial stenosis, with better outcomes in patients treated during MT. In our experience, the use of ELUTAX "3" for the treatment of symptomatic intracranial arterial stenosis achieves a progressive improvement of stenosis, evident in the first weeks, to a higher extent in cases of occlusive thrombosis. More studies are needed to provide more information about this device.
Collapse
Affiliation(s)
- Elena Elvira Soler
- Department of Neurology, 16802Alicante General University Hospital, Alicante, Spain
| | | | | | | | | | | |
Collapse
|
31
|
Influence of Vertebrobasilar Stenotic Lesion Rigidity on the Outcome of Angioplasty and Stenting. Sci Rep 2020; 10:3923. [PMID: 32127642 PMCID: PMC7054424 DOI: 10.1038/s41598-020-60906-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/31/2020] [Indexed: 11/08/2022] Open
Abstract
Stenotic lesion rigidity (SLR) has an unclear influence on the outcome of percutaneous transluminal angioplasty and stenting (PTAS) for intracranial arterial stenosis. This study evaluated the outcome of PTAS and the relationship of vertebrobasilar SLR to features on vessel wall MRI (VW-MRI) for identifying pathologies of vertebrobasilar stenosis (VBS) and evaluating PTAS outcome. We retrospectively evaluated the results of PTAS in 31 patients with severe VBS. Stenotic lesions were classified as soft (based on predilatation pressure [PP] ≦ 4 atm) in 15 patients or hard (PP >4 atm) in 16 patients. We examined the relationship of SLR to clinical and MR findings. Patients with hard vs soft lesions had atherosclerosis (8/16 [50.0%] vs 2/15 [13.3%]), dissection (0/16 [0.0%] vs 12/15 [80.0%]), and dissection in atherosclerosis (8/16 [50.0%] vs 1/15 [6.7%], P < 0.0001); high intensity signal on the T1WI of VW-MRI (5/16 [31.3%] vs 14/15 [93.3%]) and iso- to low intensity signal (11/16 [68.7%] vs 1/15 [6.7], P = 0.001), and significant in-stent restenosis (>50%) in 5/15 (33.3%) vs 0/15 (0.0%) (P = 0.0421) in the 30 patients who successfully completed PTAS. Vertebrobasilar SLR correlated well with lesion etiology, findings on VW-MRI, and PTAS outcome. Patients with hard stenotic lesions need close follow-up after PTAS.
Collapse
|
32
|
Stracke CP, Fiehler J, Meyer L, Thomalla G, Krause LU, Lowens S, Rothaupt J, Kim BM, Heo JH, Yeo LLL, Andersson T, Kabbasch C, Dorn F, Chapot R, Hanning U. Emergency Intracranial Stenting in Acute Stroke: Predictors for Poor Outcome and for Complications. J Am Heart Assoc 2020; 9:e012795. [PMID: 32122218 PMCID: PMC7335566 DOI: 10.1161/jaha.119.012795] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Stent‐retriever thrombectomy is the first‐line therapy in acute stroke with intracranial large vessel occlusion. In case of failure of stent‐retriever thrombectomy, rescue stent angioplasty might be the only treatment option to achieve permanent recanalization. This study aims at identifying predictors for poor outcome and complications in a large, multicenter cohort receiving rescue stent angioplasty. Methods and Results We performed a retrospective analysis of patients with large vessel occlusion who were treated with rescue stent angioplasty after stent‐retriever thrombectomy between 2012 and 2018 in 7 neurovascular centers. We defined 2 binary outcomes: (1) functional clinical outcome (good modified Rankin Scale, 0–2; and poor modified Rankin Scale, 4–6) and (2) early symptomatic intracerebral hemorrhage. Impacts of clinical, radiological, and interventional parameters on outcomewere assessed in uni‐ and multivariable logistic regression models. Two hundred ten patients were included with target vessels located within the anterior circulation (136 of 210; 64.8%) and posterior circulation (74 of 210; 35.2%). Symptomatic intracerebral hemorrhage occured in 22 patients, 86.4% (19 of 22) after anterior and 13.6% (3 of 22) after posterior circulation large vessel occlusion. Good functional outcome was observed in 44.8% (73 of 163). A higher National Institutes of Health Stroke Scale on admission (adjusted odds ratio, 1.10; P=0.002), a higher premorbid modified Rankin Scale (adjusted odds ratio, 2.02; P=0.049), and a modified Thrombolysis in Cerebral Infarction score of 0 to 2a after stenting (adjusted odds ratio, 23.24; P<0.001) were independent predictors of poor functional outcome. Conclusions Use of rescue stent angioplasty can be considered for acute intracranial large vessel occlusion in cases after unsuccessful stent‐retriever thrombectomy. Likelihood of symptomatic intracerebral hemorrhage is higher in anterior circulation stroke.
Collapse
Affiliation(s)
- Christian Paul Stracke
- Department of Intracranial Endovascular Therapy Alfried-Krupp Krankenhaus Hospital Essen Germany.,Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Götz Thomalla
- Department of Neurology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Lars Udo Krause
- Department of Neurology Klinikum Osnabruck Osnabruck Germany
| | - Stephan Lowens
- Department of Radiology Klinikum Osnabruck Osnabruck Germany
| | - Jan Rothaupt
- Department of Radiology Klinikum Osnabruck Osnabruck Germany
| | - Byung Moon Kim
- Department of Radiology Interventional Neuroradiology Severance Stroke Center Severance Hospital Yonsei University College of Medicine Seoul South Korea
| | - Ji Hoe Heo
- Department of Neurology Severance Stroke Center Severance Hospital Yonsei University College of Medicine Seoul South Korea
| | - Leonard L L Yeo
- Department of Neuroradiology Karolinska University Hospital Stockholm Sweden.,Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Division of Neurology Department of Medicine National University Health System Singapore
| | - Tommy Andersson
- Department of Neuroradiology Karolinska University Hospital Stockholm Sweden.,Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,Department Medical Imaging AZ Groeninge Kortrijk Belgium
| | | | - Franziska Dorn
- Department of Neuroradiology University Hospital of Munich Germany
| | - Rene Chapot
- Department of Intracranial Endovascular Therapy Alfried-Krupp Krankenhaus Hospital Essen Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg-Eppendorf Hamburg Germany
| |
Collapse
|
33
|
Djurdjevic T, Cunha A, Schulz U, Briley D, Rothwell P, Küker W. Endovascular treatment of patients with high-risk symptomatic intracranial vertebrobasilar stenoses: long - term outcomes. Stroke Vasc Neurol 2020; 4:182-188. [PMID: 32030201 PMCID: PMC6979875 DOI: 10.1136/svn-2019-000230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/23/2019] [Accepted: 04/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background and purpose We present the long-term outcome after endovascular treatment of symptomatic intracranial posterior circulation stenoses. Methods 30 patients with symptomatic intracranial posterior circulation stenoses exceeding 70% underwent endovascular treatment between 2006 and 2012. Data regarding presentation, follow-up, procedure details, complications and imaging follow-up were reviewed. All surviving patients underwent a phone interview to establish their current Modified Ranking Scales (MRS). Results Stenoses of the intracranial vertebral artery (24 patients) and basilar artery (6 patients) were treated with stents (10 patients), angioplasty alone (13 patients) or both (5 patients). Two procedures failed. One patient (3.3%) died after the procedure, two had stroke (6.6%) and one a subarachnoid haemorrhage without ensuing deficit. Two patients (6.7%) had asymptomatic complications (dissection and pseudoaneurysm). The median clinical follow-up time was 7 years. Of the 29 patients who survived the procedure, 6 died due to unrelated causes. Three patients (10%) had recurrent strokes and two (6.7%) a transient ischaemic attack in the posterior circulation. Two patients had subsequent middle cerebral artery strokes. Five (16.7%) patients had recurrent stenoses and three (10%) occlusions of the treated artery. Retreatment was performed in six patients, three (10%) with PTA and three (10%) with stenting. Current MRS scores were as follows: nine MRS 0, eight MRS 1, four MRS 2 and one MRS 4. Conclusions Long-term follow-up after endovascular treatment of high-risk symptomatic intracranial posterior circulation stenoses shows few stroke recurrences. Treatment of intracranial vertebral artery stenosis may be beneficial in appropriately selected patients.
Collapse
Affiliation(s)
- Tanja Djurdjevic
- Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - André Cunha
- Department of Neuroradiology, Centro Hospitalar Gaia/Espinho, Vila Nova de Gaia, Portugal.,Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ursula Schulz
- Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Dennis Briley
- Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Neurology, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - Peter Rothwell
- Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Wilhelm Küker
- Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
34
|
Gruber P, Remonda L. Device profile of different paclitaxel-coated balloons: Neuro Elutax SV, Elutax '3' Neuro and SeQuent Please NEO for the treatment of symptomatic intracranial high-grade stenosis: overview of their feasibility and safety. Expert Rev Med Devices 2020; 17:87-92. [PMID: 31962054 DOI: 10.1080/17434440.2020.1719829] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Intracranial atherosclerotic disease (ICAD) is highly prevalent and probably the most common cause of stroke worldwide. Despite best medical treatment (BMT), the rate of recurrent stroke in symptomatic ICAD patients is elevated, especially in those with high-grade stenosis. Thus, alternative treatment options are needed. So far, endovascular ICAD treatment has been considered a second-line therapy. However, recent progress in the endovascular acute stroke treatment challenges this issue. Drug-coated balloon (DCB) - percutaneous transluminal angioplasty (PTA) represents a promising alternative to BMT alone.Areas covered: In this review, current clinical studies on paclitaxel-coated DCB-PTA in symptomatic high-grade ICAD patients will be presented and discussed. Furthermore, technical profile of the different paclitaxel-coated DCB, which has been used for intracranial use (Neuro Elutax SV, Elutax '3' Neuro, and SeQuent Please NEO) are being presented.Expert opinion: Despite limited data and its experimental (off-line) use, DCB-PTA has been demonstrated to be feasible and safe in selected ICAD patients with symptomatic high-grade stenosis. DCB-PTA offers several advantages compared to alternative endovascular therapy option as well as BMT alone. Consequently, DCP-PTA might be a promising candidate for the future armamentarium in ICAD treatment.
Collapse
Affiliation(s)
- Philipp Gruber
- Department of Neuroradiology, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Luca Remonda
- Department of Neuroradiology, Cantonal Hospital of Aarau, Aarau, Switzerland
| |
Collapse
|
35
|
Zhao W, Zhang J, Song Y, Sun L, Zheng M, Yin H, Zhang J, Wang W, Han J. Endovascular Recanalization for Symptomatic Subacute to Chronic Atherosclerotic Basilar Artery Occlusion. Front Neurol 2019; 10:1290. [PMID: 31920916 PMCID: PMC6923246 DOI: 10.3389/fneur.2019.01290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The prognosis is poor for patients with symptomatic subacute to chronic atherosclerotic basilar artery occlusion (BAO) refractory to medical therapy. There has been no consensus on the optimal treatment for these patients until now. Objectives: To assess the feasibility of endovascular recanalization for patients with symptomatic subacute to chronic atherosclerotic BAO refractory to medical therapy. Methods: Consecutive patients who underwent endovascular recanalization for symptomatic subacute to chronic symptomatic atherosclerotic BAO from May 2015 to October 2018 were enrolled in our stroke center. Demographic, clinical, angiographic, procedural, and follow-up data were collected and analyzed. Results: Twenty-one patients were enrolled in this study [mean age 57.9 years; 90.5% male; median pretreatment National Institutes of Health Stroke Scale (NIHSS) score 10; median time from image-documented BAO to treatment 15 days]. The success rate of the procedure was 81.0% (17/21). Periprocedural perforator strokes occurred in two patients (9.5%, 2/21). At 90 days, there was one death due to pneumonia (unrelated to the procedure), and there were no recurrent cases of TIA or stroke in the other 16 patients. At 90 days, 76.5% (13/17) of patients achieved a good clinical outcome [mRS: modified Rankin Scale (mRS) scores 0–2], and 94.1% (16/17) of patients achieved an acceptable outcome (mRS scores 0–3). During the 17.4 ± 8.0-month clinical follow-up period, one patient suffered from Wallenberg syndrome at 29 months. Conclusions: Our study suggests that endovascular recanalization for subacute to chronic symptomatic atherosclerotic BAO appears to be feasible in selected patients.
Collapse
Affiliation(s)
- Wei Zhao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jinping Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yun Song
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Lili Sun
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Meimei Zheng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Hao Yin
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jun Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Wei Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Ju Han
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.,Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| |
Collapse
|
36
|
Gruber P, Berberat J, Kahles T, Anon J, Diepers M, Nedeltchev K, Remonda L. Angioplasty Using Drug-Coated Balloons in Ostial Vertebral Artery Stenosis. Ann Vasc Surg 2019; 64:157-162. [PMID: 31639484 DOI: 10.1016/j.avsg.2019.10.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ostial vertebral artery stenosis (OVAS) is a relevant cause of acute ischemic posterior circulation stroke. Percutaneous trans-luminal angioplasty (PTA) might offer a promising treatment modality, but restenosis rate is high. So far, little is known about recanalization using drug-coated balloons (DCB) in OVAS. We aimed to show feasibility and safety of DCB-PTA in OVAS. METHODS Retrospective, monocenter case series of 12 patients with ostial vertebral artery stenosis (≥50%) treated with PTA using a drug-coated balloon. RESULTS Median age was 69.5 years (IQR 57-78.5) with a female rate of 41%. Patients were treated either with a SeQuent Please NEO or Neuro Elutax SV DEB. Median preinterventional stenosis degree was 75% (IQR 70-85) with a median lesion length of 4.5 mm (IQR 4-7.5). Median postinterventional stenosis degree was 40% (IQR 27-50). All treated vessels remained patent. No major complications such as dissection, vessel perforation, hemorrhage, or ischemic events occurred. Moreover, we did not detect any restenosis during a median follow-up period of 6.1 months. The clinical outcome was excellent with median mRS scale of 0 (IQR 0-1). CONCLUSIONS PTA using drug-coated balloons is feasible and safe in patients with ostial vertebral artery stenosis.
Collapse
Affiliation(s)
- Philipp Gruber
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland; Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
| | - Jatta Berberat
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Timo Kahles
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Javier Anon
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Michael Diepers
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland; University of Bern, Bern, Switzerland
| | - Luca Remonda
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland; University of Bern, Bern, Switzerland
| |
Collapse
|
37
|
Zhang Y, Sun Y, Li X, Liu T, Liu P, Wang H, Ding J, Miao ZR, Li G. Early versus delayed stenting for intracranial atherosclerotic artery stenosis with ischemic stroke. J Neurointerv Surg 2019; 12:274-278. [PMID: 31285375 DOI: 10.1136/neurintsurg-2019-015035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the clinical outcomes of early stenting (≤14 days) or late stenting (>14 days) in patients who underwent intracranial stent placement. METHODS Patients with ischemic stroke caused by 70-99% intracranial atherosclerotic stenosis combined with poor collaterals were enrolled. The early stenting group, who underwent stenting within 14 days of last ischemic symptoms, were compared with the late stenting group who underwent stenting >14 days from last ischemic symptom. The patients were treated either with a balloon-mounted stent or a self-expanding stent as determined by the operators following a guideline. The baseline characteristics and clinical outcomes were evaluated and compared. RESULTS One hundred and fifteen stroke patients were recruited into the study. Four patients (4/41) in the early stenting group and two patients (2/74) in the late stenting group were diagnosed with a cerebral vascular event associated with stenting within 3 days (p=0.184). In the long-term follow-up, eight patients in the early stenting group had restenosis ≥50%, which was higher than patients in the late stenting group (8/41 vs 4/74, p=0.018). The total rates of any ischemic stroke, transient ischemic attack, hemorrhagic stroke, and death in the early stenting group were higher than in the late stenting group (9/41 vs 6/74, p=0.035). The recurrence rate of ischemic stroke in the early stenting group was higher than in the late stenting group (5/41 vs 2/74, p=0.041). CONCLUSIONS Stent placement in the setting of ischemic stroke caused by intracranial artery stenosis within 14 days may confer a higher risk of long-time cerebral vascular events and lead to a higher risk of restenosis. CLINICAL TRIAL REGISTRATION NCT01968122.
Collapse
Affiliation(s)
- Yong Zhang
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yujie Sun
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xin Li
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tonghui Liu
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Peng Liu
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hongxia Wang
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jian Ding
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhong-Rong Miao
- Department of Neurology and Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, China
| | - Guangwen Li
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| |
Collapse
|
38
|
Stracke CP, Meyer L, Fiehler J, Leischner H, Bester M, Buhk JH, Thomalla G, Krause LU, Lowens S, Rothaupt J, Chapot R, Hanning U. Intracranial bailout stenting with the Acclino (Flex) Stent/NeuroSpeed Balloon Catheter after failed thrombectomy in acute ischemic stroke: a multicenter experience. J Neurointerv Surg 2019; 12:43-47. [DOI: 10.1136/neurintsurg-2019-014957] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 11/03/2022]
Abstract
Background and purposeTo report on the feasibility, safety, and outcome of acute intracranial stenting (ICS) with the Acclino (Flex) Stent and NeuroSpeed Balloon Catheter in cases of failed mechanical thrombectomy (MT) for acute ischemic stroke (AIS).MethodsWe retrospectively reviewed the data of patients treated with acute bailout stenting after failed MT in three large neurointerventional centers using exclusively the Acclino (Flex) Stent and the NeuroSpeed Balloon Catheter. Functional outcome was assessed by the rate of major early neurological recovery (mENR) at 24 hours and at 90 days with the modified Rankin Scale (mRS). Safety evaluation included symptomatic intracranial hemorrhage (sICH), mortality, and intervention-related serious adverse events (SAEs).Results50 patients with a median age of 71 years met the inclusion criteria and 52% (26/50) of the occluded vessels were located within the anterior circulation. mENR was observed in 38.8% and 90-day favorable outcome (mRS ≤2) was 40.6% (13/32). Higher NIH Stroke Scale scores on admission were significantly associated with poor functional outcome (mRS ≥3) at 90 days (adjusted OR 1.28; 95% CI 1.07 to 1.53; p=0.007). sICH occurred in two cases of the study population. There were no intervention-related SAEs.ConclusionIntracranial bailout stenting with the Acclino (Flex) Stent and the NeuroSpeed Balloon Catheter after failed MT is a feasible and effective recanalization method for atherosclerotic stenosis-based stroke that is associated especially with low rates of sICH.
Collapse
|
39
|
Zheng M, Song Y, Zhang J, Zhao W, Sun L, Yin H, Zhang J, Wang W, Han J. Endovascular Recanalization of Non-acute Symptomatic Middle Cerebral Artery Total Occlusion and Its Short-Term Outcomes. Front Neurol 2019; 10:484. [PMID: 31156533 PMCID: PMC6529837 DOI: 10.3389/fneur.2019.00484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: The optimal treatment for patients with non-acute symptomatic middle cerebral artery (MCA) total occlusion and a high risk of recurrent ischemic stroke despite medical management is not well-established. We aimed to assess the feasibility, safety, and short-term outcomes of angioplasty and stenting for these patients. Methods: Data of 22 patients with non-acute symptomatic MCA total occlusion who have failed medical management and undergone endovascular recanalization were retrospectively collected in our prospective database. All occlusive lesions were predilated with conventional balloons, followed by paclitaxel-coated coronary balloon inflation or not, and then a remedial stenting was performed or not, depending on the discretion of the operator. The rate of successful recanalization, perioperative outcomes, and short-term outcomes, such as restenosis and stroke recurrence, was analyzed. Results: Successful recanalization was achieved in 95.5% of patients, with 14 patients undergoing balloon angioplasty and 7 patients undergoing remedial stenting. Seven patients developed perioperative complications, including one patient with persistent neurological deficit. Over a median clinical follow-up duration of 5.0 months, only one patient had recurrent ischemic symptoms attributed to the cessation of antiplatelet treatment owing to postoperative intracranial hemorrhage. The proportion of patients who achieved favorable clinical outcome (modified ranking scale score of 0-2) was 85.7%. Post-procedural repeat vascular imaging was performed at 4.5 ± 1.84 months, with nine and one patient undergoing cerebral angiography and magnetic resonance angiography, respectively. One (10%) artery presented with asymptomatic reocclusion. Conclusions: Angioplasty and stenting may be feasible for the patients with non-acute symptomatic atherosclerotic MCA total occlusive disease who have failed medical management.
Collapse
Affiliation(s)
- Meimei Zheng
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Shandong University, Jinan, China
| | - Yun Song
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Shandong University, Jinan, China
| | - Jinping Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Shandong University, Jinan, China
| | - Wei Zhao
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Shandong University, Jinan, China
| | - Lili Sun
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Shandong University, Jinan, China
| | - Hao Yin
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Shandong University, Jinan, China
| | - Jun Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Shandong University, Jinan, China
| | - Wei Wang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Shandong University, Jinan, China
| | - Ju Han
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Shandong University, Jinan, China
| |
Collapse
|
40
|
Li G, Wang N, Li X, Ma N, Liu T, Sun Y, Liu P, Miao Z, Zhang Y. Balloon-Mounted versus Self-Expanding Stent Outcomes in Symptomatic Middle Cerebral Artery Stenosis Combined with Poor Collaterals in China: A Multicenter Registry Study. World Neurosurg 2019; 124:e675-e681. [PMID: 30659967 DOI: 10.1016/j.wneu.2018.12.189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/20/2018] [Accepted: 12/23/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the technical and 1-year clinical outcome in balloon-mounted versus self-expanding stenting for symptomatic severe stenosis of the middle cerebral artery combined with poor collaterals in China. METHODS Ninety-one patients with severe middle cerebral artery atherosclerotic stenosis combined with poor collaterals were recruited in the study. Balloon-mounted stent or self-expanding stent were selected to treat patients following a guideline. The baseline characteristics, cerebral angiography, and outcomes were compared between the patients treated with balloon-mounted stent and self-expanding stent. RESULTS The mean degree of stenosis was 85.5% ± 6.37% in the balloon-mounted stenting group and 85.4% ± 7.73% in the self-expanding stenting group before treatment (P = 0.930). A longer operative time occurred in patients treated with self-expanding stent than in those treated with balloon-mounted stent (96.7 vs. 68.6 minutes, respectively; P = 0.002). Patients with self-expanding stent had a higher rate of residual stenosis than those with balloon-mounted stent (67.3% vs. 38.9%, respectively; P = 0.014). The patients in balloon-mounted stenting group was less likely to have restenosis (6.1% vs. 26.5%, P = 0.019) and had a lower degree of stenosis (5.0% ± 0.0% vs. 26.9% ± 29.2%, P = 0.019) compared with patients in the self-expanding stenting group. During the 1-year follow-up, the recurrence rate of ischemic stroke, transient ischemic attack, hemorrhage stroke, and death was not significantly different between the 2 groups (1/33 vs. 2/49, P = 0.804; 1/33 vs. 1/49, P = 0.776; 0/33 vs. 2/49, P = 0.240; 1/33 vs. 0/49, P = 0.220, respectively). CONCLUSIONS Balloon-mounted stents may have a shorter operative time and lower restenosis occurrence than self-expanding stents. No significant difference in 1-year outcome was observed between the 2 groups.
Collapse
Affiliation(s)
- Guangwen Li
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Naidong Wang
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xin Li
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ning Ma
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tonghui Liu
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yujie Sun
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Liu
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhongrong Miao
- Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Zhang
- Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| |
Collapse
|
41
|
Gruber P, Braun C, Kahles T, Hlavica M, Anon J, Diepers M, Nedeltchev K, Berberat J, Remonda L. Percutaneous transluminal angioplasty using the novel drug-coated balloon catheter SeQuent Please NEO for the treatment of symptomatic intracranial severe stenosis: feasibility and safety study. J Neurointerv Surg 2018; 11:719-722. [DOI: 10.1136/neurintsurg-2018-014378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 11/03/2022]
Abstract
ObjectivesIntracranial arteriosclerotic disease is a relevant cause of ischemic stroke worldwide with a high recurrence rate despite best medical treatment. Following the SAMMPRIS trial, endovascular treatment has remained a second-line therapy. Meanwhile, there has been significant advances in device technology. SeQuent Please NEO is a novel polymer-free, drug-coated (paclitaxel/iopromide) balloon (DCB) primarily designed for cardiology. Because of its high flexibility and pushability, it may also be suitable for intracranial use. The aim of this study was to assess the feasibility and safety of SeQuent Please NEO DCB in symptomatic intracranial severe stenosis.MethodsA single-center retrospective cohort study of patients with symptomatic intracranial severe stenosis treated with SeQuent Please NEO DCB was performed at a tertiary stroke center.ResultsTen patients (all men, median age 73 years (IQR 69–77)) were included. Median pre-treatment stenosis grade was 78% (IQR 75–80%) with four internal carotid artery, two mid-basilar artery, and four vertebral artery lesions. Median post-treatment stenosis grade was 50% (IQR 45–53%). Successful angioplasty was achieved in all cases without technical failure. There were no cases of peri-procedural reocclusion and no deaths at median follow-up of 3 months (IQR 2–3).ConclusionIn this pilot study, SeQuent Please NEO DCB was feasible and safe in the treatment of symptomatic intracranial severe stenosis. It might represent a promising alternative to medical treatment in selected cases.
Collapse
|
42
|
Han J, Zhang J, Zhang X, Zhang J, Song Y, Zhao W, Zheng M, Sun L, Wang W. Drug-coated balloons for the treatment of symptomatic intracranial atherosclerosis: initial experience and follow-up outcome. J Neurointerv Surg 2018; 11:569-573. [PMID: 30337378 DOI: 10.1136/neurintsurg-2018-014237] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/21/2018] [Accepted: 10/02/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND The optimal treatment for patients with symptomatic severe intracranial atherosclerotic disease is not well established. Angioplasty and stenting have been attempted, with controversial results, mainly attributed to perioperative complications and a high incidence of restenosis or in-stent restenosis. Drug-coated balloons (DCBs) have shown encouraging results for coronary and peripheral artery disease, without convincing data for intracranial vasculature. OBJECTIVES To assess the feasibility, clinical and angiographic outcomes of DCBs for patients with intracranial de novo atherosclerotic disease. METHODS Between September 2016 and September 2017, details of 30 patients with 31 arteries treated with DCBs for symptomatic severe intracranial atherosclerotic disease (≥70% stenosis or chronic total occlusion) were retrospectively collected in our centre. All lesions were predilated with conventional balloons. Periprocedural complications and clinical and vascular imaging follow-up outcomes were analysed. RESULTS All arteries were successfully dilated with DCBs and 29 (93.5%) arteries achieved good antegrade perfusion, with remedial stenting for two arteries. Two patients presented with new ischemic stroke after the procedure. Over a mean follow-up of 9.8±2.6 months, no patient had recurrent ischemic symptoms. Repeat vascular imaging was performed at 7.0±1.1 months, with cerebral angiography in 24 patients (25 arteries) and MR angiography in six patients (six arteries). Only one (3.2%) artery presented with angiographic asymptomatic restenosis. CONCLUSIONS This study suggests that DCB dilatation may be a safe and effective alternative for intracranial de novo atherosclerotic disease.
Collapse
Affiliation(s)
- Ju Han
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jun Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Xiao Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jinping Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yun Song
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Wei Zhao
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Meimei Zheng
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Lili Sun
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Wei Wang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| |
Collapse
|