Is Stent Retraction to ReLieve Arterial Cerebral VaSospasm Caused by SAH (Stent-ReLACSS) Using PRELAX the Long-awaited Solution for Treatment of Posthemorrhagic Cerebral Vasospasm? : Treatment of Posthemorrhagic Cerebral Vasospasm with PRESET and PRELAX: Technical Aspects, Efficacy, and Safety Margins in a Case Series

PURPOSE

Recent observational studies have indicated the efficacy of stent retriever devices for the treatment of posthemorrhagic cerebral vasospasm (CVS), both by deployment and on-site withdrawal into the microcatheter (stent angioplasty, SA) and deployment followed by retraction through the target vessel similar to thrombectomy (Stent Retraction to reLieve Arterial Cerebral vaSospasm caused by SAH, Stent-ReLACSS). This article reports the findings with each application of pRESET and pRELAX in the treatment of CVS.

METHODS

We retrospectively enrolled 25 patients with severe CVS following aneurysmal subarachnoid hemorrhage. For the SA group, a stent retriever or a pRELAX was temporarily deployed into a narrow vessel segment and retrieved into the microcatheter after 3 min. For the Stent-ReLACSS group, a pRELAX was temporarily deployed into a narrow vessel and pulled back unfolded into the internal carotid artery. If intra-arterial vasodilators were administered, they were given exclusively after mechanical vasospasmolysis to maximize the effectiveness of the stent treatment.

RESULTS

In this study fifteen patients and 49 vessels were treated with SA. All were technically successful without periprocedural complications; however, 8/15 patients (53.3%) required additional treatment of the CVS. A total of 10 patients and 23 vessel segments were treated with Stent-ReLACSS. All maneuvers were technically successful without periprocedural complications and all vessels showed significant angiographic improvement. No recurrent CVS requiring further endovascular treatment occurred in-hospital, and neither territorial ischemia in the treated vessels nor vascular injury were observed in follow-up angiography.

CONCLUSION

Based on the presented data it appears that Stent-ReLACSS with pRELAX does not pose any additional risks when used to treat CVS and might be superior to SA, especially concerning mid-term and long-term efficacy. The mechanism of action may be an effect on the endothelium rather than mechanical vasodilation. As many patients with CVS are diagnosed too late, prophylactic treatment of high-risk patients (e.g., poor grade, young, female) is potentially viable.

The Vascular Quality Initiative assessment of the Bard Lifestent for the treatment of popliteal artery occlusive disease

OBJECTIVE

The Bard LifeStent self-expanding stent is approved for the treatment of occlusive disease involving the superficial femoral artery and proximal popliteal artery. We conducted a post-market trial of treatment of the popliteal artery above and below the knee (P1, P2, and P3 segments) within the Society for Vascular Surgery Vascular Quality Initiative (VQI) Peripheral Vascular Intervention registry.

METHODS

A single-arm, prospective trial was conducted at 29 VQI sites in the United States, enrolling 74 patients from November 2016 to May 2019. The primary safety outcome was freedom from major adverse events including device-/procedure-related mortality and major amputation at 1 year. The primary efficacy outcomes were freedom from target vessel revascularization and freedom from target lesion revascularization at 1 year. Secondary outcomes included lesion success; procedural success; primary, primary-assisted, and secondary patency; and sustained clinical (improvement in Rutherford class) and hemodynamic success (increase in ankle brachial index >0.10). Outcomes were assessed by Kaplan-Meier analysis. Arteriogram of patients undergoing target lesion revascularization were assessed for stent fracture by a core laboratory.

RESULTS

The mean age was 71 years, with 63.5% male and 55% with diabetes. The indication was claudication 28% and chronic limb-threatening ischemia in 72%. The superficial femoral artery-popliteal artery was stented in 38% and the popliteal artery alone in 62%. The majority of stents were placed in the P1 + P2 (39%) or P1 + P2 + P3 (37%) segments of the popliteal artery. The composite primary endpoint of freedom from major adverse events was 82% and 74% at 1 and 2 years, respectively. Freedom from mortality was 100% and 97%, and freedom from major amputation was 100% and 90% at 1 and 12 months, with all deaths and major amputations occurring in patients with chronic limb-threatening ischemia. freedom from target lesion revascularization was 86%, and freedom from target vessel revascularization was 84% at 12 months. At discharge, lesion treatment success was 99%, and procedural success was 82%. Primary patency was 80% and 72%, primary-assisted patency was 80% and 72%, and secondary patency was 89% and 82% at 12 and 24 months. Sustained clinical success was 98% and 95%, and sustained hemodynamic success was 100% and 79% at 12 and 24 months.

CONCLUSIONS

In this multi-center, registry-based, single-arm prospective study the Bard LifeStent self-expanding stent demonstrated favorable performance in the challenging anatomy of the P2 and P3 popliteal segment. Post-market studies for label expansion of peripheral vascular intervention devices can be successfully conducted within the Society for Vascular Surgery VQI registry.

Basilar artery stenosis: Technical tips for endovascular revascularization

The SAMMPRIS Trial concluded that medical treatment of intracranial stenosis was safer than intracranial stenting. The key reasons for a poor outcome with stenting were significantly more perioperative ischemic strokes and higher rates of intracerebral hemorrhages. To the contrary, WEAVE trial showed significantly lower morbidity and mortality when stenting was performed one week following the ictus. We describe the technical approach for safe basilar artery stenting through radial approach. A middle aged male presented with recurrent posterior circulation symptoms despite being on dual antiplatelet therapy. A right radial approach was undertaken. A 5f radial sheath was exchanged for an AXS infinity LS (Stryker Neurovascular, Ireland) 6 f sheath after priming the radial artery. Using a quadri-axial approach, 0.014' Traxcess microwire (Microvention Inc, Tustin, USA), 0.017' Echelon microcatheter (Microtherapeutics.inc. Ev3 Neurovascular, USA), 0.038 DAC (Stryker Neurovascular USA) & 5F Navien (Microtherapeutics.inc. Ev3 USA), the Infinity sheath was taken into the V2 segment of the right vertebral artery. The 5F Navien (tri-axial approach) was taken upto the distal V4 segment of the vertebral artery. The 3d rotational angiography directed runs revealed > 95 % stenosis of mid basilar segment. No significant ostial stenosis of side branch was noted and in view of long segment plaque angioplasty followed by deployment of self-expanding stent was planned. The microcatheter (0.017') and microwire (Traxcess 0.014') was navigated across the stenosis. Thereafter, an exchange maneuver was performed to allow for sequential slow balloon angioplasty with 1.5 mm × 15 (Maverick, Boston Scientific) and 2.5 mm× 15 (Trek, Abbott costa rica) coronary balloon. Following that a CREDO 4 × 20 mm stent (Acandis GmbH., Pforzheim Germany) was deployed across the stenosis. All exchange maneuvers were performed under biplane fluoroscopy and microwire was kept under watch. The patient was on aspirin and clopidogrel and activated clotting time was maintained around 250 s throughout the procedure. A closure device was applied post procedure. Blood pressure was monitored in neurointensive care unit and patient was discharged on the third day following procedure. Right radial approach, distal position of the sheath, distal position of the guiding catheter, careful analysis of the 3d rotational angiography for risk of side branch occlusion, biplane fluoroscopy during exchanges and slow angioplasty were the key safety checks during procedure.

Torcular dural AVF: Transvenous onyx embolisation with sinus reconstruction

Transvenous onyx (Microtherapeutics, Irvine, CA, USA) embolization with sinus reconstruction using a venous balloon is a novel technique to embolise dural arterial venous fistula while preserving the sinus. We elucidate the technical tips and tricks that were employed to treat this torcular dural AVF in an elderly male with visual disturbances secondary to papilledema. Right external carotid artery injection revealed a type 2c fistula along the torcula with feeders from the right parietal & petrosal branches of the middle meningeal artery and dural branches of the posterior auricular and the occipital artery. The right distal transverse and the sigmoid were occluded with retrograde flow into the superior sagittal sinus and the cortical veins. XPER CTA analysis revealed the fistula point to be along the wall of the torcula. Through right femoral artery access, a neuron max (Penumbra inc.USA) was placed in the right common carotid artery. An eclipse (Balt Extrusion, France) 6 × 12 mm single lumen balloon was placed in the proximal ECA to achieve flow reduction. Thereafter, through bilateral femoral venous approach, two neuron max 8 F (Penumbra inc.USA) were placed into the left jugular vein. A Copernic RC balloon 10×80 mm (Balt Extrusion, France) was placed from the left to the right transverse sinus. Further, two microcatheters, 1.5 F Marathon (Medtronic, Minneapolis, MI, USA) were navigated into the feeding arteries from the venous end. Microcatheter injections were taken with inflation of the venous balloon to determine the point at which sinus and cortical vein reflux is absent. Following that onyx 18 was injected under biplane fluoroscopy with an adequately inflated arterial and venous balloon. We could achieve retrograde permeation of the onyx into the fistula and the arterial feeders resulting in complete occlusion while preserving the sinus. Careful analysis of the angioarchitecture of the fistula and evaluating for delayed cerebral venous drainage is the key to determining the right strategy to achieve complete occlusion of the fistula.

Computational modeling of braided venous stents - Effect of design features and device-tissue interaction on stent performance

Designing venous stents with desired properties is challenging due to the partly conflicting performance criteria, e.g., enhancing flexibility may be at odds with increasing patency. To evaluate the effect of design parameters on the mechanical performance of braided stents, computational simulations are performed using finite element analysis. Model validation is performed through comparison with measurements. Considered design features are stent length, wire diameter, pick rate, number of wires, and stent end-type, being either open-ended or closed looped. Based on the requirements of venous stents, tests are defined to study the effect of design variations with respect to the following key performance criteria: chronic outward force, crush resistance, conformability, and foreshortening. Computational modeling is demonstrated to be a valuable tool in the design process through its ability of assessing sensitivities of various performance metrics to the design parameters. Additionally, it is shown, using computational modeling, that the interaction between a braided stent and its surrounding anatomy has a significant impact on its performance. Therefore, taking into account device-tissue interaction is crucial for the proper assessment of stent performance.

Comparative effectiveness of endovascular treatment modalities for de novo femoropopliteal lesions in intermittent claudication: A network meta-analysis of randomized controlled trials

PURPOSE

To evaluate the most effective endovascular treatment modalities for de novo femoropopliteal lesions in intermittent claudication (IC) in terms of technical success, primary patency, target lesion revascularization (TLR) and all-cause mortality through network meta-analysis of randomized controlled trials.

METHODS

Medical databases were searched on December 3, 2020. 16 studies (3265 patients) and 7 treatments were selected. Outcomes were technical success, primary patency, TLR and mortality at 6 and/or 12 months.

RESULTS

Regarding 6-month primary patency, drug-eluting stents (DES) was better than balloon angioplasty (BA; odds ratio [OR], 23.27; 95% confidence interval [CI], 12.57-43.06), drug-coated balloons (DCB; OR, 5.63; 95% CI, 2.26-14.03) and directional atherectomy (DA; OR, 31.52; 95% CI, 7.81-127.28), and bare nitinol stents (BNS) was better than BA (OR, 17.91; 95% CI, 7.22-44.48), DCB (OR, 4.33; 95% CI, 1.40-13.45) and DA (OR, 24.27; 95% CI, 5.16-114.11). Regarding 12-month primary patency, DES was better than BA (OR, 10.05; 95% CI, 4.56-22.16), DCB (OR, 3.70; 95% CI, 1.54-8.89) and DA (OR, 29.54; 95% CI, 7.26-120.26). DCB and combination of balloon and atherectomy were the most effective treatment regarding 12-month TLR and technical success (residual stenosis <30%), respectively. DES, BNS and DA with DCB (DA-DCB) were included in the best cluster in the clustered ranking plot combining 12-month primary patency and TLR.

CONCLUSIONS

Balloon and atherectomy may confer advantages over other treatments for technical success; DCB may for TLR. Stent technologies confer substantial advantages regarding primary patency. Stent technologies and DA-DCB should be given priority in treating femoropopliteal lesions in IC.

Experience in the management of neoplastic gastric outlet obstruction in patients at the Hospital Universitario San Ignacio in Bogotá, Colombia

INTRODUCTION

Malignant gastric outlet obstruction is a condition that alters patient quality of life, conditioning progressive malnutrition. However, self-expanding metal stents (SEMSs) and surgical gastrojejunostomy (SGJ) are palliative options in patients with unresectable disease.

AIM

To characterize patients diagnosed with malignant gastric outlet obstruction requiring SEMS placement or SGJ.

MATERIALS AND METHODS

Sequential non-probability convenience sampling was conducted and included 68 patients, 40 of whom had SEMS placement and 28 of whom underwent SGJ.

RESULTS

Patients sought medical consultations for the symptoms of vomiting, abdominal pain, weight loss, and upper gastrointestinal bleeding. Ninety-five percent of the patients in the SEMS group and 64.3% in the SGJ group presented with metastasis. Technical and clinical success, patency duration, and number of patients with no complications were greater in the SGJ group. Mean survival in days was 88 (SD ± 21) in the SEMS group versus 501 (SD ± 122) in the SGJ group. The log-rank test detected a statistically significant difference between subgroups (p = 0.00).

CONCLUSION

SGJ has greater technical and clinical success rates but SEMS placement continues to be utilized in distal gastric cancer, especially in cases in which surgery is not an option.

Three-Year Clinical Outcomes of the Innova™ Self-Expanding Nitinol Stent for the Treatment of Femoropopliteal Lesions

PURPOSE

To report the 3-year results of Innova™ stent implantation for the treatment of femoropopliteal (FP) lesions in a real-world setting.

METHODS

This single-arm, retrospective, multicenter clinical study analyzed 481 lesions from 453 consecutive patients with symptomatic peripheral artery diseases (Rutherford category 1-6) who underwent endovascular therapy with implantation of Innova™ self-expanding nitinol stent for FP lesions. The primary outcome measure was the 3-year restenosis rate based on doppler-ultrasound or angiographic criteria. The secondary outcome measures included the rates of 3-year major amputation and major adverse limb events.

RESULTS

Restenosis following Innova™ implantation was found in 61% of the cases at 3 years. At the end of 3 years, the rates of major amputations and major adverse limb events were 3 and 31%, respectively. In cases free from restenosis at 1 year, no predictive factors for restenosis at 3 years could be determined.

CONCLUSION

The present study demonstrated mid-term clinical outcomes after Innova™ stent implantation for the treatment of FP lesions in a real-world population. The Innova™ stent demonstrated acceptable clinical outcomes in a real-world setting.

Experience in the management of neoplastic gastric outlet obstruction in patients at the Hospital Universitario San Ignacio in Bogotá, Colombia

INTRODUCTION

Malignant gastric outlet obstruction is a condition that alters patient quality of life, conditioning progressive malnutrition. However, self-expanding metal stents (SEMSs) and surgical gastrojejunostomy (SGJ) are palliative options in patients with unresectable disease.

AIMS

To characterize patients diagnosed with malignant gastric outlet obstruction requiring SEMS placement or SGJ.

MATERIALS AND METHODS

Sequential non-probability convenience sampling was conducted and included 68 patients, 40 of whom had SEMS placement and 28 of whom underwent SGJ.

RESULTS

Patients sought medical consultations for the symptoms of vomiting, abdominal pain, weight loss, and upper gastrointestinal bleeding. Ninety-five percent of the patients in the SEMS group and 64.3% in the SGJ group presented with metastasis. Technical and clinical success, patency duration, and number of patients with no complications were greater in the SGJ group. Mean survival in days was 88 (SD ± 21) in the SEMS group versus 501 (SD ± 122) in the SGJ group. The log-rank test detected a statistically significant difference between subgroups (p = 0.00).

CONCLUSION

SGJ has greater technical and clinical success rates but SEMS placement continues to be utilized in distal gastric cancer, especially in cases in which surgery is not an option.

A novel transcatheter aortic valve with a form-fitting anchor for self-alignment: feasibility in a chronic preclinical model

OBJECTIVES

Our goal was to assess the viability of an alternative anchoring design for a transcatheter aortic valve based on a form-fitting principle with a self-expanding nitinol frame to reduce issues related to excess radial force.

METHODS

A 26-mm outer diameter prototype of a self-expanding nitinol frame was developed to reduce the amount of necessary radial force by utilizing additional anchoring via protruding arms in each aortic sinus, thus allowing for a form-fitting principle as well as the coaxial self-alignment of the valve inside the native anatomy. The prototype valve was implanted via a transapical approach in the orthotopic position in 2 sheep. Follow-up examinations were performed at regular intervals during a 3-month period to confirm adequate function and anchoring.

RESULTS

Observation demonstrated secure, facilitated positioning with perfect alignment of the stent in the aortic sinuses. Repeated transthoracic echocardiography showed adequate valve function over the entire period with no change in the valve position, gradients or regurgitation. The animals remained in sinus rhythm during the entire period.

CONCLUSIONS

The prototype frame with its form-fitting properties has the potential to resolve issues related to malpositioning and excess radial force for transcatheter aortic valves as well as to extend the treatment possibilities to pure aortic insufficiencies. The stent is presently being tested in vitro for its long-term durability.

Design and Comparison of Large Vessel Stents: Balloon Expandable and Self-Expanding Peripheral Arterial Stents

Endovascular stenting has evolved over the last 50 years since its inception into the framework of management of vascular atherosclerotic disease. Stent design has evolved as lesion complexity has increased. Nevertheless, certain first principles regarding stent design have been recapitulated time and again with every iteration of endovascular stents. This article reviews principles of endovascular stent design and compares and contrasts key aspects of balloon expandable and self-expanding stents.

Novel Approaches to Reducing the Risk of Variceal Hemorrhage

BACKGROUND

Complications of advanced liver disease occur at the moment of clinical significant portal hypertension. Nitric oxide (NO) dysfunction and fibrosis play an important role in the pathophysiology of PH, but other mechanisms are also involved. Non-selective beta blockers (NSBB) stay the cornerstone in the primary and secondary prevention of variceal bleeding, but their safety in advanced cirrhosis has been recently debated and new drugs are under investigation. Transjugular intrahepatic portosystemic shunt and balloon tamponade are the standard therapy in case of refractory variceal bleeding, but both interventions have drawbacks. Key Message: Transelastography under certain conditions and the presence of collateral circulation on imaging allow to rule-in CSPH, which makes patients open at risk for variceal hemorrhage. FXR agonists are intrahepatic NO donors; they reduce fibrosis and prevent bacterial translocation, which make them promising drugs for the treatment of PH. NSBB should be used with caution in patients with refractory ascites and certainly in those with hepatorenal syndrome. Preliminary clinical data suggest that simvastatin and enoxaparin improve the prognosis of patients with cirrhosis. Finally, covered esophageal metallic stents are safer and more effective than balloon tamponade in the case of refactory variceal bleeding.

CONCLUSIONS

Liver stiffness measurements enable the selection of patients for endoscopic screening for esophageal varices. In the case of tense ascites, the dose of NSBB should be adapted to the hemodynamic condition of the patient. Self-expanding, covered esophageal metallic stents replace balloon tamponade in the treatment of massive variceal hemorrhage.

In Vitro Hydrodynamic Assessment of a New Transcatheter Heart Valve Concept (the TRISKELE)

This study presents the in vitro hydrodynamic assessment of the TRISKELE, a new system suitable for transcatheter aortic valve implantation (TAVI), aiming to mitigate the procedural challenges experienced with current technologies. The TRISKELE valve comprises three polymeric leaflet and an adaptive sealing cuff, supported by a novel fully retrievable self-expanding nitinol wire frame. Valve prototypes were manufactured in three sizes of 23, 26, and 29 mm by automated dip-coating of a biostable polymer, and tested in a hydrodynamic bench setup in mock aortic roots of 21, 23, 25, and 27 mm annulus, and compared to two reference valves suitable for equivalent implantation ranges: Edwards SAPIEN XT and Medtronic CoreValve. The TRISKELE valves demonstrated a global hydrodynamic performance comparable or superior to the controls with significant reduction in paravalvular leakage. The TRISKELE valve exhibits enhanced anchoring and improved sealing. The valve is currently under preclinical investigation.

An isolated spontaneous dissecting celiac artery aneurysm with successful endovascular treatment using stenting and coil embolization

Isolated spontaneous dissecting celiac artery aneurysm (DCAA) is a rare event. We report the case of a 50-year-old Japanese man with sudden post-prandial epigastric pain. He was diagnosed as having an isolated DCAA based on the results of contrast-enhanced multi-slice computed tomography (CT). Initially, we gave him conservative therapy, but the aneurysm grew and then we performed endovascular treatment. The DCAA did not cause a rupture, and there were rich collateral channels between the superior mesenteric artery and the common hepatic artery. However, the neck of the aneurysm was too broad to indwell coils, and it was thought that coils might drop out from the aneurysm. We chose endovascular therapy with a self-expanding stent and coil embolization, and the aneurysm was extinguished. He was successfully treated and has recovered favorably. To our knowledge, few cases of a DCAA treated with both a self-expanding stent and coil embolization have been reported and this strategy may be one of the endovascular treatment options for a DCAA. More data accumulation of this method and investigation of long-term treatment effect are required in the future. <Learning objective: A dissecting celiac artery aneurysm is a rare event. Conservative, endovascular, and surgical therapies have been described, but no optimum treatment exists. For the present patient, we chose endovascular therapy with a stent and coil embolization, and he was successfully treated. To our knowledge, few cases of this condition treated with both stenting and coiling have been reported. We suggest that this strategy be one of the endovascular treatment options for this condition.>.

Adjuvant Tirofiban Injection Through Deployed Solitaire Stent As a Rescue Technique After failed Mechanical Thrombectomy in Acute Stroke

Purpose

We present our experiences of intra-arterial tirofiban injection through a deployed Solitaire stent as a rescue therapy after failed mechanical thrombectomy in patients with acute ischemic stroke.

Materials and Methods

Data on 18 patients treated with adjunctive tirofiban injection through a temporarily deployed Solitaire stent after failed mechanical thrombectomy were retrospectively reviewed. Solitaire stent was used as a primary thrombectomy device in 16 of 18 patients. Two patients received manual aspiration thrombectomy initially. If initial mechanical thrombectomy failed, tirofiban was injected intra-arterially through the deployed Solitaire stent and then subsequent Solitaire thrombectomy was performed.

Results

Fourteen patients had occlusions in the middle cerebral artery, 2 in the distal internal carotid artery, and 2 in the basilar artery. Successful recanalization was achieved in 14 patients (77.7%) after intra-arterial injection of tirofiban and subsequent Solitaire thrombectomy. Three patients without successful recanalization after rescue method received angioplasty with stenting. Overall, successful recanalization (TICI grades 2b and 3) was achieved in 17 (94.4%) of 18 patients. Periprocedural complications occurred in 5 patients: distal migration of emboli in 5 patients and vessel perforation in 1. Three patients died. Good functional outcome (mRS ≤ 2) was achieved in 9 patients (50.0%) at 3 months.

Conclusion

Rescue intra-arterial injection of tirofiban through a temporarily deployed Solitaire stent may facilitate further recanalization in cases of failed mechanical thrombectomy in patients with acute ischemic stroke.

Comparison of Drug-eluting Coronary Stents, Bare Coronary Stents and Self-expanding Stents in Angioplasty of Middle Cerebral Artery Stenoses

Objective

The purpose of this study is to investigate the results of treatment using stent-angioplasty for symptomatic middle cerebral arterial (MCA) stenosis and comparison of in-stent restenosis between drug-eluting stents (DES), bare metal coronary stents (BMS) and self-expanding stents (SES).

Materials and Methods

From Jan. 2007 to June. 2012, 34 patients (mean age ± standard deviation: 62.9 ± 13.6 years) with MCA stenosis were treated. Inclusion criteria were acute infarction or transient ischemic attacks (TIAs) and angiographically proven symptom related severe stenosis. Stents used for treatment were DES (n = 8), BMS (n = 13) and SES (n = 13). National Institutes of Health Stroke Scale (NIHSS) at admission was 2.5 ± 3.1 and mean stenosis rate was 79.0 ± 8.2%. Assessment of clinical and angiographic results was performed retrospectively.

Results

Among 34 patients, periprocedural complications occurred in four cases (11.8%), however, only two cases (6.0%) were symptomatic. All patients were followed clinically (mean follow-up period; 40.7 ± 17.7 months) and 31 were followed angiographically (91.2%. 13.4 ± 8.5 months). There was no occurrence of repeat stroke in all patients; however, mild TIAs related to restenosis occurred in three of 34 patients (8.8%). The mean NIHSS after stent-angioplasty was 1.7 ± 2.9 and 0.8 ± 1.1 at discharge. The modified Rankin score (mRS) at discharge was 0.5 ± 0.9 and 0.3 ± 0.8 at the last clinical follow-up. In-stent restenosis over 50% occurred in five of 31 angiographically followed cases (16.1%), however, all of these events occurred only in patients who were treated with BMS or SES. Restenosis rate was 0.0% in the DES group and 20.8% in the other group (p = 0.562); it did not differ between BMS and SES (2/11 18.2%, 3/13 23.1%, p = 1.000).

Conclusion

Stent-angioplasty appears to be effective for symptomatic MCA stenosis. As for restenosis, in our study, DES was presumed to be more effective than BMS and SES; meanwhile, the results did not differ between the BMS and SES groups.

Mechanism of procedural failure related to wingspan

PURPOSE

Wingspan is the only FDA approved self-expanding stent for intracranial artery and known to have better delivery compared to balloon expandable stent. However, some delivery failure has been reported but incidence and mechanism of the failure have not been completely elucidated. We present the cause and mechanism of Wingspan deployment failure experienced in our Institute.

MATERIALS AND METHODS

We experienced deployment failure in seven patients (8.8%) out of 80 patients who underwent Wingspan stenting since 2007. Mean age of the patients was 62 (range 47~78) and male to female ratio was 6:1. We evaluated the cause and mechanism why the deployment was not successful and how we could manage it subsequently.

RESULTS

WE CATEGORIZED FAILURES OCCURRED IN SEVEN PATIENTS INTO THREE CATEGORIES: delivery failure (n = 3), deployment failure of stent (n = 3), retrieval failure of dual tapered (olive) tip of the inner body through the deployed the stent (n = 1). The technical failure in using Wingspan stent (delivery, deployment and retrieval failures) are related to tortuousness of the proximal (n =4) as well as distal (n =1) cerebral vessels to the stenotic lesion and bulky profile of the olive tip (n =2).

CONCLUSION

The technical failure in using Wingspan stent (delivery, deployment and retrieval failures) are related to tortuousness of the proximal as well as distal cerebral vessels to the stenotic lesion and bulky profile of the olive tip. To avoid device-related complication, complete understanding of the stent design is mandatory before using the stent.

Safety and efficacy of mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke: a systematic review

Purpose

In recent years, mechanical thrombectomy using Solitaire stent retrieval has been tried for treating acute ischemic stroke with a large artery occlusion. We systematically reviewed published articles to appraise the evidence that supports the safety and efficacy of the mechanical thrombectomy in acute strokes with Solitaire stent.

Materials and Methods

Systematic searches using Medline and Scopus were performed for studies evaluating mechanical thrombectomy using a Solitaire stent in acute ischemic stroke. Articles were included if they were published since 2008, contained at least 5 subjects, and provided clinical results.

Results

Thirteen articles (262 cases) were included in this review. The mean time of the procedures ranged from 37 to 95.6 minutes in 10 studies. The success of recanalization was achieved in 89.7% and the recanalization rate varied from 66.7% to 100% in all 13 studies. The overall rates of the symptomatic hemorrhagic complications and mortality were 6.8% and 11.1%, respectively. A favorable outcome of mRS 2 or under was 47.3%. Procedure-induced complications developed in 3.4%.

Conclusion

The present review suggested that mechanical thrombectomy using a Solitaire stent in acute ischemic stroke was effective in recanalizing the occluded artery. The rate of procedural complications was small.

Use of self-expanding stents for the treatment of vertebral artery ostial stenosis: a single center experience

Objective

To evaluate our early experience using self-expanding stents to treat atherosclerotic vertebral artery ostial stenosis (VAOS), with respect to technical feasibility and clinical and imaging follow-up results.

Materials and Methods

A total of 20 lesions in 20 patients underwent stenting of the VAOS using a self-expanding stent (Precise RX; Cordis Neurovascular, Miami Lakes, FL). Two patients were asymptomatic. We analyzed the technical success rate, causes of technical failure, occurrence of any vascular or neurological event, and the occurrence of any neurological abnormality or in-stent restenosis (ISR) seen on follow-up. The imaging follow-up was performed with Doppler ultrasound (DUS) as a primary screening modality.

Results

One instance of technical failure was caused by failure of the guidewire passage. The stent diameter was 5 mm, and post-stenting balloon dilatations were necessary in all cases. Stent misplacement requiring placement of an additional stent occurred in four cases. Following a 14.8 month average clinical follow-up time, two patients showed anterior circulation ischemia, which was not attributed to the VAOS we treated. Following a 13.7 month average DUS follow-up, five patients showed a mild degree of diffuse or focal intimal thickening in the stent lumen; however, none of the stenosis showed luminal loss of more than 50% and no stent fracture was noted.

Conclusion

The use of self-expanding stents for treating VAOS was technically feasible and helped to improve artery patency during our limited follow-up interval.