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Dharia AA, Byer SH, Le K, Chen X, Abraham N, Hunt S, Abraham MG. A Systematic Review and Meta-Analysis of Drug Eluting Stents for Safety and Efficacy in Intracranial Atherosclerotic Disease. Int J Neurosci 2024:1-11. [PMID: 38372660 DOI: 10.1080/00207454.2024.2313013] [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: 01/09/2024] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Advancements in arterial stenting technology have challenged prior notions favoring medical management for intracranial atherosclerotic disease (ICAD). Where previous conclusions were drawn from bare metal stent (BMS) technology, recent studies suggest drug-eluting stents (DES) are favorable due to their anti-proliferative effect, which reduces vascular remodeling. METHODS We conducted a systematic review and meta-analysis of the literature prior to August 2023 reviewing all reports of ICAD treated with DES. Our target outcomes were incidence of any stroke, transient ischemic attack (TIA), or death within 30 days (postprocedural complications), ischemic stroke in the territory of the qualifying artery beyond 30 days (long-term complications), radiographically detected in-stent restenosis rate (ISR), and symptomatic ISR during follow-up. A subgroup analysis further stratified preprocedural mean stenosis above and below 70% into severe and moderate cohorts, respectively. RESULTS PubMed, Web of Science, Cochrane and EMBASE query identified 527 candidate articles, from which 14 studies met inclusion criteria for a total of 607 patients and 640 ICAD lesions. Incidence of postprocedural complications was 7.3% (95% CI 3.9-11.7%) with subgroup analysis demonstrating significantly higher incidence in the severely stenotic group [9.0% (95% CI 4.7-14.5%)] than the moderately stenotic group [3.0% (95% CI 0.7-6.8%)]. Long-term complications were 1.2% (95% CI 0.4-2.3%). Radiographic ISR was 3.5% (95% CI 1.4-6.3%) and symptomatic ISR was 0.3% (95% CI 0.0-1.5%). CONCLUSIONS Our systematic review and meta-analysis suggest that DES can effectively reduce the risk of ISR and may be a viable treatment modality to reduce long-term complications in refractory ICAD patients.
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Affiliation(s)
- Anand A Dharia
- Department of Neurosurgery, The University of KS Medical Center, Kansas City, Kansas, USA
| | - Stefano H Byer
- Department of Neurology, The University of Kansas Medical Center, Kansas City, Kansas, USA
- School of Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin Le
- Department of Neurology, The University of Kansas Medical Center, Kansas City, Kansas, USA
- School of Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Xi Chen
- Department of Biostatistics, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nihil Abraham
- Department of Neurology, The University of Kansas Medical Center, Kansas City, Kansas, USA
- School of Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Suzanne Hunt
- Department of Biostatistics, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Michael G Abraham
- Department of Neurology, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Siddiq F, Nunna RS, Beall JM, Khan I, Khan M, Tekle WG, Ezzeldin M, Tanweer O, Burkhardt JK, Jabbour PM, Tjoumakaris SI, Herial NA, Siddiqui AH, Grandhi R, Martin RL, Qureshi AI, Hassan AE. Thirty-Day Outcomes of Resolute Onyx Stent for Symptomatic Intracranial Stenosis: A Multicenter Propensity Score-Matched Comparison With Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial. Neurosurgery 2023; 92:1155-1162. [PMID: 36700730 PMCID: PMC10553131 DOI: 10.1227/neu.0000000000002338] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/02/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Symptomatic intracranial atherosclerotic disease (sICAD) is estimated to cause 10% of strokes annually in the United States. However, treatment remains a challenge with several different stenting options studied in the past with unfavorable results. OBJECTIVE To report the 30-day stroke and/or death rate associated with intracranial stent placement for sICAD using Resolute Onyx Zotarolimus-Eluting Stent (RO-ZES) and provide a comparison with the results of Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. METHODS Prospectively maintained databases across 8 stroke centers were used to identify adult patients treated with RO-ZES for sICAD between January 2019 and December 2021. Primary end point was composite of 30-day stroke, intracerebral hemorrhage, and/or death. Propensity score matching was performed using age, hypertension, lipid disorder, cigarette smoking, and symptomatic target vessel to create a matched group for comparison between RO-ZES and the SAMMPRIS medical management and treatment groups (SAMMPRIS percutaneous angioplasty and stenting [S-PTAS]). RESULTS A total of 132 patients met the inclusion criteria for analysis (mean age: 64.2 years). Mean severity of stenosis was 81.4% (±11.4%). A total of 4 (3.03%) stroke and/or deaths were reported within 30 days of treatment in the RO-ZES group compared with 6.6% in the SAMMPRIS medical management group (OR [odds ratio] 2.26, 95% CI 0.7-9.56, P = .22) and 15.6% in the S-PTAS group (OR 5.9, 95% CI 2.04-23.4, P < .001). Propensity score match analysis of 115 patients in each group demonstrated 30-day stroke and/or death rate of 2.6% in the RO-ZES group and 15.6% in the S-PTAS group (OR 6.88, 95% CI 1.92-37.54, P < .001). CONCLUSION Patients treated with RO-ZES had a relatively low 30-day stroke and/or death rate compared with the S-PTAS group. Further large-scale prospective studies are warranted to evaluate the safety and efficacy of RO-ZES for the treatment of sICAD.
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Affiliation(s)
- Farhan Siddiq
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Ravi S. Nunna
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Jonathan M. Beall
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Inamullah Khan
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Musharaf Khan
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Wondwossen G. Tekle
- Department of Neurology, Valley Baptist—University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Mohamad Ezzeldin
- Department of Clinical Science, University of Houston, HCA Houston, Houston, Texas, USA
| | - Omar Tanweer
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Pascal M. Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Nabeel A. Herial
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adnan H. Siddiqui
- Department of Neurosurgery, University of Buffalo, Buffalo, New York, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Renee L. Martin
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Adnan I. Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Ameer E. Hassan
- Department of Neurology, Valley Baptist—University of Texas Rio Grande Valley, Harlingen, Texas, USA
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Cho WS, Choi JH, Kwon OK. Neurotoxicity of Paclitaxel and Rapamycin in a Rat Model with Transient Blood-Brain Barrier Opening. J Korean Neurosurg Soc 2022; 65:180-185. [PMID: 35172471 PMCID: PMC8918238 DOI: 10.3340/jkns.2021.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/10/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Drug-eluting stents and balloons are occasionally used to reduce restenosis in medically intractable intracranial atherosclerotic stenosis. The authors aimed to determine whether such drugs can cause neurotoxicity due to local effects in a rat model. Methods Intra-arterial catheters were placed in the right common carotid artery of rats. Mannitol was injected to transiently open the brain-blood barrier (BBB), followed by high-dose drug (paclitaxel and rapamycin) injection. The optimal time interval of transient BBB opening for maximal drug penetration was determined to be 10 minutes. Paclitaxel and rapamycin were intraarterially administered in various doses. All the rats were neurologically evaluated, and their brain tissues were histologically examined. Results Neither neurological deficits nor histological abnormalities were observed in all the rats. Conclusion Paclitaxel and rapamycin did not cause neurotoxicity in a rat model with transient BBB opening.
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Affiliation(s)
- Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jung Hoon Choi
- Department of Anatomy, College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Sarathy D, Elghareeb M, Clark A, Zelmanovich R, Lucke-Wold B. Update on Clinical Management with Neurovascular Stents. JOURNAL OF EXPERIMENTAL NEUROLOGY 2022; 3:49-59. [PMID: 36578295 PMCID: PMC9793883 DOI: 10.33696/neurol.3.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endovascular stenting has continued to evolve given the new trials. Several new stents have recently been developed to address specific purposes. In this focused review, we discuss the concepts of neurointerventional stents and address the clinical implications. Furthermore, each type of stent is discussed with supporting evidence for clinical utility. In the final component, we argue for continued development and utilization.
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Affiliation(s)
- Danyas Sarathy
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | | | - Alec Clark
- Department of Neurosurgery, University of Florida, Gainesville, USA
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