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Nunna RS, Ma X, Genovese S, Lodhi A, Bains NK, Cohen D, Smith C, Ortiz MJ, Siddiq F, Gomez CR, Qureshi AI. Impact of post-procedure stenosis on outcomes of patients with severe intracranial stenosis treated with intracranial stent placement. J Neurointerv Surg 2025; 17:154-158. [PMID: 38471761 DOI: 10.1136/jnis-2023-021223] [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: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The optimal target post-procedure stenosis after percutaneous angioplasty and stent placement (PTAS) for intracranial stenosis is unknown. We determined the effect of post-procedure stenosis after intracranial PTAS on subsequent clinical events in patients with severe symptomatic intracranial stenosis. METHODS We categorized the severity of post-procedure stenosis as '<30%', '30-49%', and '≥50%' among 207 patients who underwent PTAS in a multicenter randomized clinical trial. Outcomes included stroke or death within 72 hours and within 30 days, ipsilateral stroke beyond 30 days of treatment, and stroke or death within 30 days or stroke in the qualifying artery beyond 30 days (primary endpoint of the trial). Cox proportional hazards analysis was performed with adjustments for age, initial severity of stenosis, location of stenosis, and qualifying event. Kaplan-Meier curves were generated for the primary endpoint stratified by post-procedure stenosis with log-rank analysis. RESULTS The severity of post-procedure stenosis was categorized as <30%, 30-49%, and ≥50% in 112, 73, and 22 patients, respectively. Compared with patients with post-procedure stenosis <30%, there was no difference in the risk of primary endpoint among patients with post-procedure stenoses of 30-49% (hazards ratio (HR) 0.85, 95% confidence interval (95% CI) 0.64 to 1.15) or those with ≥50% (HR 0.91, 95% CI 0.57 to 1.43). Log-rank analysis did not demonstrate a difference in rates of primary endpoint between groups stratified by post-procedure stenosis (P=0.70). CONCLUSION In the absence of any benefit on short- and long-term outcomes, strategies to achieve a low severity of post-procedure stenosis among patients with severe intracranial stenosis may not be warranted.
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Affiliation(s)
- Ravi S Nunna
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Xiaoyu Ma
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Sabrina Genovese
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Abdullah Lodhi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Navpreet K Bains
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - David Cohen
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Caitlyn Smith
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Michael J Ortiz
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Farhan Siddiq
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Camilo R Gomez
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
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Hassan AE, Shoman AM, Miller S, Hagrass AI, Desai S, Saei H, Tekle WG. The resolute Onyx in TIA management (ROTIA). Interv Neuroradiol 2024:15910199241249211. [PMID: 38651294 PMCID: PMC11571162 DOI: 10.1177/15910199241249211] [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: 02/10/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND First-line treatment for symptomatic intracranial atherosclerotic disease (ICAD) is medical management; however, interventional approaches are increasingly considered for refractory disease. The Resolute Onyx in TIA management (ROTIA) study is a post-market evaluation of the Resolute Onyx (R-Onyx) drug-eluting stent in the treatment of recurrent transient ischemic attacks (TIAs) due to refractory ICAD (off-label use). METHODS This is a single-center, retrospective case series of consecutive patients who underwent angioplasty and stenting with R-Onyx for treatment of recurrent TIAs due to refractory ICAD from October 2019 to November 2022. Included patients were ages 22-80, had a baseline modified Rankin Scale of ≤2, and had recurrent TIAs attributed to intracranial artery stenosis >70% despite maximal medical therapy. Primary outcomes of interest were peri-procedural complications (TIA, stroke, intracranial hemorrhage, mortality) up to 72 h post-stenting and ischemic stroke up to 18 months post-stenting. RESULTS Twenty patients (mean age 66.84 ± 14; 25% female; 80% Hispanic) were included. A total of 21 stents were successfully deployed with no peri-procedural complications. There were no recurrent ischemic events at 30 days post-stenting. At 18 months post-stenting, there were no ischemic events and no patient exhibited in-stent restenosis. CONCLUSION ROTIA demonstrates the feasibility of using the Resolute Onyx drug-eluting stent for the management of TIAs due to refractory ICAD, with high technical success and low peri-procedural complications. Limitations include the retrospective and single-center nature of this study. Future prospective, multi-center, randomized trials with extended observation periods are needed.
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Affiliation(s)
- Ameer E Hassan
- Clinical Research Department, Valley Baptist Medical Center – Harlingen, Harlingen, TX, USA
- Department of Neurology, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Ahmed M Shoman
- Clinical Research Department, Valley Baptist Medical Center – Harlingen, Harlingen, TX, USA
- Mansoura University Hospitals, Mansoura, Dakahlia, Egypt
| | - Samantha Miller
- Clinical Research Department, Valley Baptist Medical Center – Harlingen, Harlingen, TX, USA
| | | | - Sohum Desai
- Clinical Research Department, Valley Baptist Medical Center – Harlingen, Harlingen, TX, USA
- Department of Neurology, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Hamzah Saei
- Clinical Research Department, Valley Baptist Medical Center – Harlingen, Harlingen, TX, USA
| | - Wondwossen G Tekle
- Clinical Research Department, Valley Baptist Medical Center – Harlingen, Harlingen, TX, USA
- Department of Neurology, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
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Yang L, Du H, Zhang D, Qiao Z, Su X, Han S, Gao BL, Cao Q. Complications and long-term in-stent restenosis of endovascular treatment of severe symptomatic intracranial atherosclerotic stenosis and relevant risk factors. Medicine (Baltimore) 2023; 102:e34697. [PMID: 37747021 PMCID: PMC10519467 DOI: 10.1097/md.0000000000034697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/07/2023] [Accepted: 07/20/2023] [Indexed: 09/26/2023] Open
Abstract
To investigate the complications and in-stent restenosis of endovascular treatment of severe symptomatic intracranial atherosclerotic stenosis and relevant risk factors. Three hundred and fifty-four consecutive patients with intracranial atherosclerotic stenosis (70%-99%) were retrospectively enrolled. The clinical data, treatment outcomes, complications and in-stent restenosis at follow-up were analyzed. The endovascular treatment was composed of balloon dilatation only in 21 (5.93%) patients, and deployment of self-expandable stents in 232 (65.54%), balloon-expandable stents in 75 (21.19%), and both balloon- and self-expandable stents in 26 (7.34%), with a total of 359 stents being successfully deployed at the stenotic location. After treatment, the residual stenosis ranged 9.2%±1.5% (range 7%-19%), which was significantly (P < .05) smaller than that before treatment. Periprocedural complications occurred in 43 patients with a complication rate of 12.15% including arterial dissection in 4 (1.13%) patients, new cerebral infarction in 21 (5.93%), cerebral hemorrhage in 12 (3.3%), and subarachnoid hemorrhage in 6 (1.69%). Hyperlipidemia [odds ratio (OR) 10.35, 95% confidence interval (CI) 4.42-24.28, and P < .0001] and location at the middle cerebral artery (MCA) (OR 4.15, 95% CI 1.92-8.97, and P < .001) were significant (P < .05) risk factors for periprocedural complications, whereas hyperlipidemia (OR 11.28, 95% CI 4.65-30.60, and P < .0001), location at the MCA (or 5.26, 95% CI 2.03-15.08, and P < .001), and angulation (OR 1.02, 95% CI 1.00-1.04, and P = .02) were significant (P < .05) independent risk factors for periprocedural complications. Follow-up was performed in 287 (81.07%) patients at 6 to 36 (28 ± 6.7) months. In-stent restenosis was present in 36 (12.54%), and female sex (OR 2.53, and 95% CI 1.27-5.06) and periprocedural complications (OR 9.18, and 95% CI 3.52-23.96) were significant (P < .05) risk factors for in-stent restenosis, with periprocedural complication (OR 9.61, and 95% CI 3.48-27.23) as the only significant (P < .0001) independent risk factor for in-stent restenosis. A certain rate of periprocedural complications and in-stent stenosis may occur in endovascular treatment of severe intracranial stenosis, and the relevant risk factors may include hyperlipidemia, MCA location, angulation at the stenosis and female sex.
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Affiliation(s)
- Lei Yang
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Shijiazhuang, Hebei, China
| | - Hong Du
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Shijiazhuang, Hebei, China
| | - Dongliang Zhang
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Shijiazhuang, Hebei, China
| | - Zongrong Qiao
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Shijiazhuang, Hebei, China
| | - Xianhui Su
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Shijiazhuang, Hebei, China
| | - Siqin Han
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Shijiazhuang, Hebei, China
| | - Bu-Lang Gao
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Shijiazhuang, Hebei, China
| | - Qinying Cao
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Shijiazhuang, Hebei, China
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Russell EJ. A Rock and a Hard Place: Benefit and Risk in the Evolving Practice of Endovascular Therapy for Intracranial Atherosclerotic Stenosis. Radiology 2023; 307:e230493. [PMID: 36975822 PMCID: PMC10323285 DOI: 10.1148/radiol.230493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Eric J. Russell
- From the Department of Radiology, Northwestern Medicine, 676 N St
Clair St, Suite 1400, Chicago, IL 60611
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