Intracranial stenting in atherosclerotic disease-recent results and challenges to face

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Medicine

Background:

• Intracranial stenting is an emerging add-on therapy for symptomatic stenoses.
• Clinical benefit remains debated due to a lack of randomized controlled trials.
• Treatment decisions rely on stroke risk with antiplatelet therapy versus registry data on stenting.

Purpose of the Study:

• To review current knowledge on intracranial stenting and medical therapy for symptomatic stenoses.
• To establish a foundation for patient selection in intracranial stenting procedures.
• To identify challenges and areas for improvement in endovascular treatment of intracranial stenoses.

Main Methods:

• Literature review summarizing current data on medical therapy and interventional stenting for intracranial stenoses.
• Analysis of existing case series and registry data for stent treatment outcomes.
• Evaluation of procedure-related complication rates and in-stent stenosis rates.

Main Results:

• The overall clinical benefit of intracranial stenting is not definitively established.
• Procedure-related complication rates and in-stent stenosis rates remain a concern.
• Endovascular treatment is not yet proven superior to medical therapy for symptomatic stenoses.

Conclusions:

• Optimization of patient selection, stent technology, and periprocedural management is crucial for endovascular treatment competitiveness.
• Current evidence suggests intracranial stenting should be limited to specialized neurovascular centers.
• Further research, particularly randomized trials, is needed to clarify the role of intracranial stenting.