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Intracranial arterial stenting for symptomatic stenoses: a Latin American experience
José Maria Modenesi Freitas1, Marco Zenteno, Yolanda Aburto-Murrieta
1Department of Neuroradiology and Neurological Endovascular Therapy, Hospital Santa Rita, São Paulo, Brazilia, CEP: 04013-004, Brazil.
Insights
Intracranial angioplasty using the Lekton Motion stent (Pharos) effectively treated stenosis in Latin American patients. This stenting procedure showed a high success rate and potential for stroke prevention with minimal complications.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Intracranial atherosclerosis disproportionately affects Asian and black populations.
- Hispanic populations exhibit a higher prevalence of intracranial artery stenosis.
- Latin American data on intracranial arterial stenting are limited.
Purpose of the Study:
- To evaluate the safety and efficacy of intracranial angioplasty with a specific stent system in a Latin American cohort.
- To assess the technical success and clinical outcomes of treating intracranial stenosis.
Main Methods:
- Retrospective analysis of an observational study involving 32 patients with 33 intracranial lesions (>50% stenosis).
- Treatment utilized the Lekton Motion stent system (now Pharos) in 6 Latin American centers over 3 years.
- Data collected included patient demographics, procedural details, and follow-up outcomes.
Main Results:
- Mean patient age was 59.3 years; 75% were male. The cohort was predominantly white Hispanic.
- Mean stenosis reduced from 68.75% to 5.16% post-procedure (P = .000).
- Mortality was 9.4%, nonfatal complications 6.2%, and stroke recurrence 0% over a mean 10.2-month follow-up. Restenosis (>50%) occurred in 8.7%.
Conclusions:
- Intracranial stenosis treatment with the Lekton Motion stent (Pharos) is technically feasible and successful.
- The stent system demonstrated efficacy in stroke prevention, with low rates of restenosis and new neurologic events.
- This study highlights the potential of advanced balloon-expandable stents in managing intracranial arterial stenosis.
Background:
The proportionally higher incidence of intracranial atherosclerosis among Asian and black patients and a greater proclivity for intracranial artery stenosis in the Hispanic population merit drawing attention to a Latin American experience with intracranial arterial stenting.
Methods:
This is a retrospective analysis of an observational study of 33 intracranial lesions (each >50% stenosis) in 32 patients treated by intracranial angioplasty in 6 Latin American centers over a 3-year period. The investigation used a unique device, a balloon-expandable stent (Lekton Motion stent system, now Pharos, Biotronik, AG, Bülach, Switzerland).
Results:
The treated patients ranged in age from 30 to 81 years (mean, 59.3 years; SD, 12 years), including 24 male and 8 female patients (sex ratio, 4:1). Two were Asians, 4 were blacks, and the rest were white Hispanic. Our mean follow-up is of 10.2 months (SD, 7.84 months), with a mortality rate of 9.4% (3/32), a nonfatal complication rate of 6.2%, and a stroke rate (rate of recurrence) of 0%. The mean pretreatment stenosis of 68.75% (SD, 14%) was reduced to a residual of 5.16% (SD, 16%) (P = .000; 95% confidence interval, 56.8%-70.3%). A control angiogram was performed in 82% of patients, and in that case, the restenosis 50% or greater was of 8.7% during the follow-up period.
Conclusion:
The treatment of intracranial stenosis with the Lekton Motion stent (Pharos) is feasible with a high technical success rate. Restenosis as well as the rate of new neurologic events during follow-up suggests some efficacy of stroke prevention by using the latest-generation, highly trackable, balloon-expandable stents.