1
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Ari O, Nas OF, Inecikli MF, Hakyemez B. The effectiveness of enterprise stent use on the treatment of intracranial atherosclerosis disease. Neuroradiol J 2022; 35:612-618. [PMID: 35392732 PMCID: PMC9513921 DOI: 10.1177/19714009221083143] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine the clinical outcome of Enterprise stent in patients with severe and symptomatic intracranial atherosclerosis. MATERIAL AND METHOD Twenty-five patients who underwent Enterprise stenting between January 2012 and March 2019 were included in this study. Exclusion criteria were previous intracranial stenting and inadequate follow-up. Technical success rates of the procedures were recorded. Clinical outcome was evaluated with pre- and post-treatment modified Rankin Scale scores. The patients were monitored for 18 months clinically and for 14.3 months radiologically. RESULTS The mean age of the 15 males and 10 females was 61.6 ± 8.19. Of these 25 patients, 6 (24%) were in the anterior system and 19 (76%) were in posterior system. The mean degree of pre-treatment stenosis was 86.4% ± 7 with the mean lesion length of 12.5 ± 7.5 mm. The residual stenosis rate was 23.8% ± 8.81. Technical success rate was 100%. There were two major complications within the first 30 days (8%). Late major complications (after 30 days) occurred in one case (4%). Stent restenosis was detected in two patients (8%). No intracranial bleeding or mortality was observed. CONCLUSION In this single-center study, we achieved high technical success and tolerable complication rates. Enterprise stent may be a good treatment alternative for severe intracranial stenosis especially in patients resistant to medical treatment when correct patient selection is made. However, further randomized controlled studies, including more cases should be carried out.
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Affiliation(s)
- Oguz Ari
- Department of Radiology, Bursa City Hospital, Turkey
| | - Omer F Nas
- Department of Radiology, School of
Medicine, Bursa Uludag University, Turkey
| | - Mehmet F Inecikli
- Department of Radiology, School of
Medicine, Bursa Uludag University, Turkey
| | - Bahattin Hakyemez
- Department of Radiology, School of
Medicine, Bursa Uludag University, Turkey
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2
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Haidegger M, Kneihsl M, Niederkorn K, Deutschmann H, Mangge H, Vetta C, Augustin M, Wünsch G, Fandler-Höfler S, Horner S, Enzinger C, Gattringer T. Blood biomarkers of progressive atherosclerosis and restenosis after stenting of symptomatic intracranial artery stenosis. Sci Rep 2021; 11:15599. [PMID: 34341413 PMCID: PMC8329296 DOI: 10.1038/s41598-021-95135-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/12/2021] [Indexed: 01/14/2023] Open
Abstract
In-stent restenosis (ISR) represents a major complication after stenting of intracranial artery stenosis (ICAS). Biomarkers derived from routine blood sampling including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) have been associated with progressive atherosclerosis. We investigated the role of CRP, NLR, PLR and MPV on the development of intracranial ISR and recurrent stroke risk. We retrospectively included all patients who had undergone stenting of symptomatic ICAS at our university hospital between 2005 and 2016. ISR (≥ 50% stenosis) was diagnosed by regular Duplex sonography follow-up studies and confirmed by digital subtraction angiography or computed tomography angiography (mean follow-up duration: 5 years). Laboratory parameters were documented before stenting, at the time of restenosis and at last clinical follow-up. Of 115 patients (mean age: 73 ± 13 years; female: 34%), 38 (33%) developed ISR. The assessed laboratory parameters did not differ between patients with ISR and those without (p > 0.1). While ISR was associated with the occurrence of recurrent ischemic stroke (p = 0.003), CRP, NLR, PLR and MPV were not predictive of such events (p > 0.1). Investigated blood biomarkers of progressive atherosclerosis were not predictive for the occurrence of ISR or recurrent ischemic stroke after ICAS stenting during a 5-year follow-up.
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Affiliation(s)
- Melanie Haidegger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
| | - Kurt Niederkorn
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Christian Vetta
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Michael Augustin
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Gerit Wünsch
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Simon Fandler-Höfler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Susanna Horner
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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3
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Raper DMS, Rutledge WC, Winkler EA, Meisel K, Callen AL, Cooke DL, Abla AA. Controversies and Advances in Adult Intracranial Bypass Surgery in 2020. Oper Neurosurg (Hagerstown) 2021; 20:1-7. [PMID: 32895706 DOI: 10.1093/ons/opaa276] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/11/2020] [Indexed: 02/02/2023] Open
Abstract
Cerebral revascularization utilizing a variety of bypass techniques can provide either flow augmentation or flow replacement in the treatment of a range of intracranial pathologies, including moyamoya disease, intracranial atherosclerotic disease, and complex aneurysms that are not amenable to endovascular or simple surgical techniques. Though once routine, the publication of high-quality prospective evidence, along with the development of flow-diverting stents, has limited the indications for extracranial-to-intracranial (EC-IC) bypass. Nevertheless, advances in imaging, assessment of cerebral hemodynamics, and surgical technique have changed the risk-benefit calculus for EC-IC bypass. New variations of revascularization surgery involving multiple anastomoses, flow preserving solutions, IC-IC constructs, and posterior circulation bypasses have been pioneered for otherwise difficult to treat pathology including giant aneurysms, dolichoectasia, and medically refractory intracranial atherosclerosis. This review provides a practical update on recent advances in adult intracranial bypass surgery.
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Affiliation(s)
- Daniel M S Raper
- Department of Neurological Surgery, University of California, San Francisco, California
| | - W Caleb Rutledge
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Karl Meisel
- Department of Neurology, University of California, San Francisco, California
| | - Andrew L Callen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Adib A Abla
- Department of Neurological Surgery, University of California, San Francisco, California
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4
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Wang Z, Wang C, Li C, Shi M, Wang S, Yang Y. Stenting for Symptomatic Intracranial Vertebrobasilar Artery Stenosis in Northeast of China: A Single-Center Study. Front Neurol 2021; 11:609286. [PMID: 33664703 PMCID: PMC7920948 DOI: 10.3389/fneur.2020.609286] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/28/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: We described the incidence of surgery-related complications to evaluate the safety of endovascular therapy for severe symptomatic intracranial vertebral basilar artery stenosis (IVBS) in our stroke center in Northeast of China. Methods: Consecutive patients with symptomatic IVBS caused by 70–99% stenosis despite standard medical treatment of antiplatelet agents plus statin were enrolled. Either balloon-mounted stent or balloon predilation plus self-expanding stent was performed. Clinical adverse events such as stroke, transient ischemic attack (TIA), and death after the surgery were documented. Radiological events such as in-stent thrombosis, dissection, and guide-wire perforation during the process were recorded as complications as well. The baseline characteristics and outcomes of patients among different Mori types were compared. Results: From January 2017 to December 2018, 97 patients with stroke or TIA due to intracranial IVBS were treated by stenting, including 30 patients with basilar artery (BA) stenosis, 55 patients with intracranial vertebral artery (V4) stenosis, and 12 patients with V4-BA stenosis. The primary events include two intracranial hemorrhage (2.1%, 2/97), seven ischemic events (7.2%, 7/97), and two death (2.1%, 2/97). The successful stent deployment rate was 98.9% (96/97). The Apollo stents were used more for Mori A lesions. Self-expanding stents were more used in Mori C lesions. Mori C lesions were more vulnerable to endovascular procedure and showed higher rate of complications than A (p = 0.008) and B type (p = 0.047). Conclusion: A high technical success rate of IVBS stenting could be achieved, and the safety was acceptable, whereas Mori C lesions were more vulnerable to endovascular procedure and showed a higher rate of complications than A and B types.
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Affiliation(s)
- Zhongxiu Wang
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Chao Wang
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Chao Li
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Mingchao Shi
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Shouchun Wang
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Yi Yang
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
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5
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Ilyas A, Chen CJ, Ironside N, Buell TJ, Chagoya G, Schmalz PG, Stetler WR, Andaluz N, James RF, Ding D. Medical Management Versus Surgical Bypass for Symptomatic Intracranial Atherosclerotic Disease: A Systematic Review. World Neurosurg 2019; 129:62-71. [DOI: 10.1016/j.wneu.2019.05.223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 11/15/2022]
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6
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Salik AE, Selcuk HH, Zalov H, Kilinc F, Cirak M, Kara B. Medium-term results of undersized angioplasty and stenting for symptomatic high-grade intracranial atherosclerotic stenosis with Enterprise. Interv Neuroradiol 2019; 25:484-490. [PMID: 30991867 DOI: 10.1177/1591019919832244] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of this retrospective study is to evaluate medium-term results of undersized balloon angioplasty and stenting for symptomatic high-grade (70-99%) stenosis of a major intracranial artery with Enterprise stent. METHODS This study included 68 consecutive symptomatic (recurrent transient ischemic attack (TIA) or ischemic stroke under dual antiplatelet treatment) patients with high-grade (70-99%) stenosis of a major intracranial artery who were endovascularly treated with undersized balloon angioplasty and Enterprise stent deployment between July 2012 and December 2017. Primary outcomes were any stroke or death within 30 days after procedure. Secondary outcomes were technical success rates, stroke and restenosis during the follow-up period. RESULTS A total of 68 lesions in 68 patients (mean age: 62 ± 7 years) were treated with a technical success rate of 99%. The degree of pre-procedural stenosis was 92 ± 6% and dropped to 12 ± 10% after stent deployment. No patient developed any stroke or death during the periprocedural period. Intracranial hemorrhage was observed in 1 (1.5%) patient. In 60 (88%) patients with available imaging follow-up in-stent restenosis was observed in 2 patients. Mean follow-up period was 22 ± 17 months (range 6-72) and none of the patients experienced recurrent TIA or stroke during the follow-up period. CONCLUSION In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results.
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Affiliation(s)
- Aysun Erbahceci Salik
- Department of Radiology, University of Health Sciences, Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hatem H Selcuk
- Department of Radiology, University of Health Sciences, Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hasanagha Zalov
- Department of Radiology, University of Health Sciences, Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Fatih Kilinc
- Department of Radiology, University of Health Sciences, Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Musa Cirak
- Department of Neurosurgery, Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Batuhan Kara
- Department of Radiology, University of Health Sciences, Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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7
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Concomitant Asymptomatic Intracranial Atherosclerotic Stenosis Increase the 30-Day Risk of Stroke in Patients Undergoing Symptomatic Intracranial Atherosclerotic Stenosis Stenting. J Stroke Cerebrovasc Dis 2017; 27:479-485. [PMID: 29056405 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/12/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, 19.1% of ischemic strokes occurred out of the territory of previously symptomatic stenosis during the mean follow-up period of 23.4 months. However, it is unknown how many ischemic strokes were due to a previously asymptomatic intracranial atherosclerotic stenosis (ICAS). The objective of this study was to investigate whether the concomitant asymptomatic ICAS influences the outcome of patients undergoing symptomatic ICAS stenting. METHODS We retrospectively reviewed 576 consecutive patients with nondisabling ischemic stroke (modified Rankin scale score of ≤3) who were treated with symptomatic ICAS (≥70% stenosis) stenting with or without concomitant asymptomatic ICAS. The baseline characteristics and the 30-day primary end points (stroke or death after stenting) were compared by bivariate and multivariable logistic analyses. RESULTS The 30-day rate of primary end points was 5.2%, which was higher in patients with concomitant asymptomatic ICAS (≥50% stenosis) than in those without asymptomatic ICAS (no stenosis or <50% stenosis) (8.9% versus 3.8%, P = .014). In patients with concomitant asymptomatic ICAS, 25% of ischemic strokes occurred out of the territory of the stented artery, whereas in patients without asymptomatic ICAS, no ischemic stroke occurred out of the territory of the stented artery. Multivariable analysis showed that concomitant asymptomatic ICAS was an independent risk factor for 30-day stroke (odds ratio = 2.37, 95% confidence interval, 1.14-5.63; P = .023). CONCLUSIONS Concomitant asymptomatic ICAS (≥50% stenosis) might increase the 30-day risk of stroke in patients undergoing symptomatic ICAS stenting.
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8
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Jang J, Kim TW, Hwang EJ, Choi HS, Koo J, Shin YS, Jung SL, Ahn KJ, Kim BS. Assessment of Arterial Wall Enhancement for Differentiation of Parent Artery Disease from Small Artery Disease: Comparison between Histogram Analysis and Visual Analysis on 3-Dimensional Contrast-Enhanced T1-Weighted Turbo Spin Echo MR Images at 3T. Korean J Radiol 2017; 18:383-391. [PMID: 28246519 PMCID: PMC5313527 DOI: 10.3348/kjr.2017.18.2.383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/01/2016] [Indexed: 01/23/2023] Open
Abstract
Objective The purpose of this study was to compare the histogram analysis and visual scores in 3T MRI assessment of middle cerebral arterial wall enhancement in patients with acute stroke, for the differentiation of parent artery disease (PAD) from small artery disease (SAD). Materials and Methods Among the 82 consecutive patients in a tertiary hospital for one year, 25 patients with acute infarcts in middle cerebral artery (MCA) territory were included in this study including 15 patients with PAD and 10 patients with SAD. Three-dimensional contrast-enhanced T1-weighted turbo spin echo MR images with black-blood preparation at 3T were analyzed both qualitatively and quantitatively. The degree of MCA stenosis, and visual and histogram assessments on MCA wall enhancement were evaluated. A statistical analysis was performed to compare diagnostic accuracy between qualitative and quantitative metrics. Results The degree of stenosis, visual enhancement score, geometric mean (GM), and the 90th percentile (90P) value from the histogram analysis were significantly higher in PAD than in SAD (p = 0.006 for stenosis, < 0.001 for others). The receiver operating characteristic curve area of GM and 90P were 1 (95% confidence interval [CI], 0.86–1.00). Conclusion A histogram analysis of a relevant arterial wall enhancement allows differentiation between PAD and SAD in patients with acute stroke within the MCA territory.
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Affiliation(s)
- Jinhee Jang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Tae-Won Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Eo-Jin Hwang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Hyun Seok Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jaseong Koo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - So-Lyung Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Kook-Jin Ahn
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Bum-Soo Kim
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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9
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Cheng L, Jiao L, Gao P, Song G, Chen S, Wang X, Ren X. Risk factors associated with in-hospital serious adverse events after stenting of severe symptomatic intracranial stenosis. Clin Neurol Neurosurg 2016; 147:59-63. [PMID: 27295603 DOI: 10.1016/j.clineuro.2016.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Severe symptomatic intracranial stenosis is an important cause of stroke. Intracranial stenting is alternatively applied to treat intracranial atherosclerotic disease. However, Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis trial (SAMMPRIS) and Vitesse Stent Ischemic Therapy trial (VISSIT) both demonstrated intracranial stenting were inferior to aggressive medical treatment. But careful patient selection probably can improve the outcome of stenting in intracranial artery stenosis. Therefore, the validation of risk factors associated with serious adverse events (SAEs) after intracranial stenting may contribute to identify patients who are at high risk of stenting therapy and benefit patient selection for stenting. PATIENTS AND METHODS Patients who underwent intracranial stenting with symptom attributable to severe (>70%) intracranial stenosis were included in our institution. In-hospital SAEs after procedure were reviewed. Risk factors associated with SAEs were analyzed using multivariable logistic regression analysis. RESULT Thirty serious adverse events (5.1%) occurred among a total of 583 patients, with a mean age of 58.1±9.7, including 13 ischemic strokes, 12 brain hemorrhages and 5 deaths. Bivariate analysis and multivariable logistic regression analysis showed age (OR=0.94, 95% CI:0.900-0.983), history of DM (OR=2.439, 95% CI:1.107-5.371), preprocedural mRS score (OR=3.076, 95% CI:1.290-7.336) and lesion site in BA (OR=9.056, 95% CI:1.147-71.524) were risk factors associated with SAEs. CONCLUSION History of DM and lesion site in BA were risk factors associated with postprocedural in-hospital SAEs after stenting of severe symptomatic intracranial stenosis. But considering of the limitation of this retrospective study, further studies are necessary to confirm our results.
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Affiliation(s)
- Lei Cheng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sichang Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaolu Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Ding D. Endovascular Management of Intracranial Aneurysms: Advances in Stenting Techniques and Technology. J Cerebrovasc Endovasc Neurosurg 2016; 17:331-3. [PMID: 27066443 PMCID: PMC4823431 DOI: 10.7461/jcen.2015.17.4.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 02/21/2015] [Accepted: 12/16/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
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11
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Bai WX, Gao BL, Li TX, Wang ZL, Cai DY, Zhu LF, Xue JY, Li ZS. Wingspan stenting can effectively prevent long-term strokes for patients with severe symptomatic atherosclerotic basilar stenosis. Interv Neuroradiol 2016; 22:318-24. [PMID: 26823331 DOI: 10.1177/1591019915623797] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/01/2015] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To investigate the safety and long-term effect of using the Wingspan stent for severe symptomatic atherosclerotic basilar artery stenosis (≥70%). MATERIALS AND METHODS Between July 2007 and April 2013, we had 91 consecutive patients (age range 41-82 years old) with symptomatic severe basilar stenosis (70-99%) who underwent Wingspan stenting at our center. All patients had stenosis-related temporary ischemic attack or strokes. We analyzed the demographic data, pre- and post-procedural cerebral angiography, technical success rate, peri-procedural complications, and clinical and imaging follow-ups. RESULTS The Wingspan stenting procedure was successful in all patients: The stenosis was reduced from 82.2% ± 5.8% pre-stenting to 15.9% ± 5.7% post-stenting. The 30-day peri-operative rate for stroke or death was 14.3%, which included ischemic stroke in 12 cases (12/91 = 13.2%) and subarachnoid hemorrhage in one case (1/91 = 1.1%), with a fatal or disabling stroke rate of 2.2%. Among the 77 patients with clinical follow-up assessment within 7-60 months (mean 31.3 ± 15.1 months) after stenting, four patients (5.2%) had posterior ischemia, including one patient with disabling ischemic stroke (1.3%) and three patients (3.9%) with temporary ischemic attack. The 2-year cumulative stroke rate was 16% (95% CI: 8.2-23.8%). Among 46 patients with imaging assessments at 3-45 months (mean, 9.5 ± 8.3) post-stenting, six (13.0%) patients had restenosis, including two (2/46 = 4.3%) with symptomatic restenosis. CONCLUSIONS The benefit of stenting for patients with severe basilar artery stenosis (> 70%) may lie in lowering the long-term fatal and disabling stroke rate; and as long as the peri-operative stroke rate can be kept at a relatively lower level, patients with severe basilar stenosis can benefit from basilar artery stenting.
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Affiliation(s)
- Wei-Xing Bai
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Bu-Lang Gao
- Department of Medical Research, Shijiazhuang First Hospital, Hebei Medical University, China
| | - Tian-Xiao Li
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Zi-Liang Wang
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Dong-Yang Cai
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Liang-Fu Zhu
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Jiang-Yu Xue
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Zhao-Shuo Li
- Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
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Miao Z, Zhang Y, Shuai J, Jiang C, Zhu Q, Chen K, Liu L, Li B, Shi X, Gao L, Liu Y, Wang F, Li Y, Liu T, Zheng H, Wang Y, Wang Y. Thirty-Day Outcome of a Multicenter Registry Study of Stenting for Symptomatic Intracranial Artery Stenosis in China. Stroke 2015; 46:2822-9. [PMID: 26286544 DOI: 10.1161/strokeaha.115.010549] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/21/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although recent trials have suggested that stenting is worse than medical therapy for patients with severe symptomatic intracranial atherosclerotic stenosis, it is not clear whether this conclusion applies to a subset of patients with hypoperfusion symptoms. To justify for a new trial in China, we performed a multicenter prospective registry study to evaluate the safety and efficacy of endovascular stenting within 30 days for patients with severe symptomatic intracranial atherosclerotic stenosis.
Methods—
Patients with symptomatic intracranial atherosclerotic stenosis caused by 70% to 99% stenosis combined with poor collaterals were enrolled. The patients were treated either with balloon-mounted stent or with balloon predilation plus self-expanding stent as determined by the operators following a guideline. The primary outcome within 30 days is stroke, transient ischemic attack, and death after stenting. The secondary outcome is successful revascularization. The baseline characteristics and outcomes of the 2 treatment groups were compared.
Results—
From September 2013 to January 2015, among 354 consecutive patients, 300 patients (aged 58.3±9.78 years) were recruited, including 159 patients treated with balloon-mounted stent and 141 patients with balloon plus self-expanding stent. The 30-day rate of stroke, transient ischemic attack, and death was 4.3%. Successful revascularization was 97.3%. Patients treated with balloon-mounted stent were older, less likely to have middle cerebral artery lesions, more likely to have vertebral artery lesions, more likely to have Mori A lesions, less likely to have Mori C lesions, and likely to have lower degree of residual stenosis than patients treated with balloon plus self-expanding stent.
Conclusions—
The short-term safety and efficacy of endovascular stenting for patients with severe symptomatic intracranial atherosclerotic stenosis in China is acceptable. Balloon-mounted stent may have lower degree of residual stenosis than self-expanding stent.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01968122.
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Affiliation(s)
- Zhongrong Miao
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Yong Zhang
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Jie Shuai
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Changchun Jiang
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Qiyi Zhu
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Kangning Chen
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Li Liu
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Baomin Li
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Xiangqun Shi
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Lianbo Gao
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Yajie Liu
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Feng Wang
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Yongli Li
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Tieyan Liu
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Hongbo Zheng
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Yilong Wang
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
| | - Yongjun Wang
- From the Departments of Interventional Neuroradiology (Z.M.) and Neurology (Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Department of Neurology, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China (Y.Z.); Department of Neurology, Xin Qiao Hospital, Third Military Medical University, Chongqing, China
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Starke RM, Komotar RJ, Connolly ES. Randomized Clinical Trial of Balloon-Expandable Intracranial Stenting Versus Aggressive Medical Therapy for Symptomatic Intracranial Arterial Stenosis. Neurosurgery 2015; 77:N11-2. [PMID: 26379174 DOI: 10.1227/01.neu.0000471834.87972.e9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Robert M Starke
- University of Virginia School of Medicine, Charlottesville, Virginia University of Miami School of Medicine, Miami, Florida Columbia University College of Physicians and Surgeons, New York, New York
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14
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Ding D, Chen CJ, Starke RM, Liu KC, Crowley RW. Ophthalmologic course of bilateral abducens nerve palsies after the treatment of idiopathic intracranial hypertension with venous sinus stenting. Neurol Sci 2015; 36:2297-9. [PMID: 26255302 DOI: 10.1007/s10072-015-2365-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, 22908, USA.
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, 22908, USA
| | - Robert M Starke
- Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, 22908, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, 22908, USA.,Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, 22908, USA
| | - R Webster Crowley
- Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, 22908, USA.,Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, 22908, USA
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15
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Ding D, Chen CJ, Starke RM, Liu KC, Crowley RW. Rapid recovery of bilateral abducens nerve palsies after venous sinus stenting for idiopathic intracranial hypertension. J Neurol Sci 2015; 357:335-7. [PMID: 26253703 DOI: 10.1016/j.jns.2015.07.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/14/2015] [Accepted: 07/30/2015] [Indexed: 12/28/2022]
Affiliation(s)
- Dale Ding
- University of Virginia, Department of Neurosurgery, P.O. Box 800212, Charlottesville, VA 22908, United States.
| | - Ching-Jen Chen
- University of Virginia, Department of Neurosurgery, P.O. Box 800212, Charlottesville, VA 22908, United States
| | - Robert M Starke
- University of Virginia, Department of Neurosurgery, P.O. Box 800212, Charlottesville, VA 22908, United States
| | - Kenneth C Liu
- University of Virginia, Department of Neurosurgery, P.O. Box 800212, Charlottesville, VA 22908, United States; University of Virginia, Department of Radiology and Medical Imaging, P.O. Box 800170, Charlottesville, VA 22908, United States
| | - R Webster Crowley
- University of Virginia, Department of Neurosurgery, P.O. Box 800212, Charlottesville, VA 22908, United States; University of Virginia, Department of Radiology and Medical Imaging, P.O. Box 800170, Charlottesville, VA 22908, United States
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16
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Ding D. Expanding the boundaries of endovascular aneurysm treatment: emerging technologies for wide-necked bifurcation aneurysms. Acta Neurochir (Wien) 2015; 157:1049-50. [PMID: 25236934 DOI: 10.1007/s00701-014-2238-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Dale Ding
- University of Virginia Department of Neurosurgery Surgery, P.O. Box 800212, Charlottesville, VA, 22908, USA,
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17
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Gao P, Zhao Z, Wang D, Wu J, Cai Y, Li T, Wu W, Shi H, He W, Zhu F, Jiao L, Ling F. China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis (CASSISS): A new, prospective, multicenter, randomized controlled trial in China. Interv Neuroradiol 2015; 21:196-204. [PMID: 25934656 DOI: 10.1177/1591019915581778] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with symptomatic stenosis of intradural arteries are at high risk for subsequent stroke. Since the SAMMPRIS trial, stenting is no longer recommended as primary treatment; however, the results of this trial, its inclusion criteria and its center selection received significant criticism and did not appear to reflect our experience regarding natural history nor treatment complications rate. As intracranial atherosclerosis (ICAS) is the most common cause for stroke in Asian countries, we are hereby proposing a refined prospective, randomized, multicenter study in an Asian population with strictly defined patient and participating center inclusion criteria. METHODS The China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis (CASSISS) trial is an ongoing, government-funded, prospective, multicenter, randomized trial. It recruits patients with recent TIA or stroke caused by 70%-99% stenosis of a major intracranial artery. Patients with previous stroke related to perforator ischemia will not be included. Only high-volume centers with a proven track record will enroll patients as determined by a lead-in phase. Patients will be randomized (1:1) to best medical therapy alone or medical therapy plus stenting. Primary endpoints are any stroke or death within 30 days after enrollment or after any revascularization procedure of the qualifying lesion during follow-up, or stroke in the territory of the symptomatic intracranial artery beyond 30 days. The CASSISS trial will be conducted in eight sites in China with core imaging lab review at a North American site and aims to have a sample size of 380 participants (stenting, 190; medical therapy, 190). Recruitment is expected to be finished by December 2016. Patients will be followed for at least three years. The trial is scheduled to complete in 2019. CONCLUSION In the proposed trial, certain shortcomings of SAMMPRIS including patient and participating center selection will be addressed. The present manuscript outlines the rationale and design of the study. We estimate that this trial will allow for a critical reappraisal of the role of intracranial stenting for selected patients in high-volume centers.
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Affiliation(s)
- Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital of the Ministry of Health, China
| | - Jian Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, China
| | - Yiling Cai
- Department of Neurology, the 306 Hospital of PLA, China
| | - Tianxiao Li
- Department of Intervention, Henan Provincial People's Hospital, China
| | - Wei Wu
- Department of Neurology, Qilu Hospital of Shandong University, China
| | - Huaizhang Shi
- Department of Neurosurgery, The 1st Affiliated Hospital of Harbin Medical University, China
| | - Weiwen He
- Department of Neurology, The 2nd Affiliated Hospital of Guangzhou Medical College, China
| | - Fengshui Zhu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China
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18
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Ding D. Management of intracranial atherosclerotic disease: current roles of medical therapy versus stent-assisted revascularization. Neurol Sci 2015; 36:1531-2. [PMID: 25868599 DOI: 10.1007/s10072-015-2214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/09/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, 22908, USA,
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19
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Salem M, Gross BA, Du R, Thomas AJ. Cerebrovascular neurosurgery 2014. J Clin Neurosci 2015; 22:775-8. [PMID: 25691077 DOI: 10.1016/j.jocn.2015.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/06/2015] [Accepted: 01/10/2015] [Indexed: 11/29/2022]
Abstract
Continued advances in our understanding of the management of cerebrovascular disease were made in 2014. A randomized trial for management of unruptured brain arteriovenous malformation (ARUBA) (Mohr et al. Lancet 2014;383:614-21.) and the Scottish intracranial vascular malformation study (Al-Shahi Salman et al. JAMA 2014;311:1661-9) were published and contrasted with reports based on extensive surgical experience. We highlight the results from the simvastatin in aneurysmal subarachnoid hemorrhage study (STASH) (Kirkpatrick et al. Lancet Neurol 2014;13:666-75) which unfortunately did not demonstrate a benefit of simvastatin on outcome in patients with aneurysmal subarachnoid hemorrhage. The 10 year follow-up of the international subarachnoid aneurysm trial (ISAT) (Molyneux et al. Lancet 2014 [E-pub]) and the 3 year follow-up results from the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS) (Derdeyn et al. Lancet 2014;383:333-41) were also reported. Results from the Japan adult Moyamoya trial (JAM) (Miyamoto et al. Stroke 2014;45:1415-21) are also briefly reviewed. Furthermore, benefits of familial screening for relatives of intracranial aneurysm and arteriovenous malformation patients, a promising angioscopic experience for endovascular procedures, as well as a modified bypass technique for management of complex aneurysms are outlined. The largest literature series to date for coiling large and giant aneurysms together with the midterm results of the Solitaire stent (ev3, Irvine, CA, USA) aneurysm remodeling study in coiling wide-necked aneurysms (SOLARE) are also presented (Gory et al. Neurosurgery 2014;75:215-9).
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Affiliation(s)
- Mohamed Salem
- Department of Neurological Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Bradley A Gross
- Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Rose Du
- Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Ajith J Thomas
- Department of Neurological Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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20
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Modern management of paraclinoid aneurysms: rise of flow diversion and fall of microsurgery. Clin Neurol Neurosurg 2015; 131:90-1. [PMID: 25662782 DOI: 10.1016/j.clineuro.2015.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/17/2015] [Indexed: 11/23/2022]
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21
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Leung TW, Wang L, Soo YOY, Ip VHL, Chan AYY, Au LWC, Fan FSY, Lau AYL, Leung H, Abrigo J, Wong A, Mok VCT, Ng PW, Tsoi TH, Li SH, Man CBL, Fong WC, Wong KS, Yu SCH. Evolution of intracranial atherosclerotic disease under modern medical therapy. Ann Neurol 2015; 77:478-86. [PMID: 25557926 DOI: 10.1002/ana.24340] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/26/2014] [Accepted: 12/07/2014] [Indexed: 01/05/2023]
Affiliation(s)
- Thomas W. Leung
- Division of Neurology, Department of Medicine and Therapeutics
| | - Lily Wang
- Division of Neurology, Department of Medicine and Therapeutics
| | | | | | - Anne Y. Y. Chan
- Division of Neurology, Department of Medicine and Therapeutics
| | - Lisa W. C. Au
- Division of Neurology, Department of Medicine and Therapeutics
| | | | - Alex Y. L. Lau
- Division of Neurology, Department of Medicine and Therapeutics
| | - Howan Leung
- Division of Neurology, Department of Medicine and Therapeutics
| | - Jill Abrigo
- Department of Diagnostic and Interventional Radiology; Prince of Wales Hospital, Chinese University of Hong Kong
| | - Adrian Wong
- Division of Neurology, Department of Medicine and Therapeutics
| | | | - Ping Wing Ng
- Department of Medicine and Geriatrics; United Christian Hospital
| | - Tak Hong Tsoi
- Department of Medicine; Pamela Youde Nethersole Eastern Hospital
| | - Siu Hung Li
- Department of Medicine; North District Hospital
| | | | - Wing Chi Fong
- Department of Medicine; Queen Elizabeth Hospital; Hong Kong
| | - Ka Sing Wong
- Division of Neurology, Department of Medicine and Therapeutics
| | - Simon C. H. Yu
- Department of Diagnostic and Interventional Radiology; Prince of Wales Hospital, Chinese University of Hong Kong
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22
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Starke RM, Komotar RJ, Connolly ES. Long-term outcomes of a randomized clinical trial of stenting vs aggressive medical therapy for intracranial arterial stenosis. Neurosurgery 2014; 75:N19-21. [PMID: 25232790 DOI: 10.1227/01.neu.0000454761.45120.2a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Robert M Starke
- University of Virginia School of Medicine, Charlottesville, Virginia University of Miami School of Medicine, Miami, Florida Columbia University College of Physicians and Surgeons, New York, New York
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23
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Ding D. Alterations in treatment preferences for intracranial atherosclerotic disease following SAMMPRIS. Cerebrovasc Dis 2014; 37:391. [PMID: 24968891 DOI: 10.1159/000362112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Dale Ding
- Department of Neurological Surgery, University of Virginia, Charlottesville, Va., USA
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24
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Ding D. Assessment of elastin degradation as a surrogate measurement of atherosclerotic plaque stability. Clin Neurol Neurosurg 2014; 121:76-7. [DOI: 10.1016/j.clineuro.2014.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 01/25/2014] [Indexed: 11/16/2022]
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25
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Ding D. Intracranial stenting for large vessel recanalization in acute ischemic stroke. Clin Neurol Neurosurg 2014; 122:129. [PMID: 24792754 DOI: 10.1016/j.clineuro.2014.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/07/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Dale Ding
- University of Virginia, Department of Neurosurgery, Charlottesville, USA.
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26
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Ding D. Effect of SAMMPRIS on endovascular interventions for intracranial atherosclerosis. Clin Neurol Neurosurg 2014; 120:145. [PMID: 24680398 DOI: 10.1016/j.clineuro.2014.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Dale Ding
- University of Virginia, Department of Neurosurgery, P.O. Box 800212, Charlottesville 22908, USA.
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27
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Ding D, Starke RM. Evidence-based optimization of the management of intracranial atherosclerotic disease. Neurol Sci 2014; 35:1311-2. [PMID: 24643581 DOI: 10.1007/s10072-014-1722-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/13/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, 22908, USA,
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