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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Cerebral Nitinol Stenting in Progressive Stroke and in Crescendo TIAs
Or Cohen-Inbar1, Yaaqov Amsalem2
1Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel.
Insights
Percutaneous transluminal angioplasty and stenting (PTAS) using the LEO+ stent effectively treated progressive stroke and crescendo TIAs. This intervention improved neurologic function in patients unresponsive to medical care.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Acute ischemic stroke (AIS) is a leading cause of death, often due to arterial stenosis.
- Current treatment guidelines for AIS and TIAs are debated, with no specific protocols for progressive stroke or crescendo TIAs.
- Percutaneous transluminal angioplasty and stenting (PTAS) is a potential treatment, but stent risks necessitate careful selection.
Purpose of the Study:
- To evaluate the efficacy of the LEO+ nitinol flexible self-expanding stent for treating progressive cerebrovascular accident or crescendo TIAs.
- To assess the safety and functional outcomes of PTAS in patients with severe cerebral arterial narrowing.
Main Methods:
- Twelve patients with progressive stroke or crescendo TIAs, unresponsive to medical management, were included.
- Patients underwent PTAS using LEO+ nitinol stents for major cerebral arterial narrowing.
- Clinical and radiographic follow-up was conducted for all patients.
Main Results:
- Sixteen LEO+ nitinol stents were placed in twelve patients (ages 17-80) over 20 months.
- All treated patients demonstrated moderate to substantial improvement in neurological function post-procedure.
- No immediate major complications were reported related to stent placement.
Conclusions:
- PTAS with the LEO+ stent is a viable treatment option for progressive stroke or crescendo TIAs with suitable anatomy.
- This approach can lead to significant improvements in functional and neurological status.
- Further research is warranted to establish definitive guidelines for PTAS in these conditions.
Background:
Acute ischemic stroke (AIS) is the third leading cause of death. Arterial stenosis is a common cause of stroke, with a high risk of recurrent stroke. Treatment guidelines for AIS and transient ischemic attack (TIA) are still under debate. Treatment guidelines for progressive stroke or crescendo TIAs do not exist. Percutaneous transluminal angioplasty and stenting (PTAS) is an increasingly attractive treatment option, whose efficacy is yet to be proven. However, stent placement poses both short- and long-term risks such as immediate ischemic events, in-stent stenosis, and stent breakage. Thus the choice of stent type is critical. We report our experience with the LEO + (Balt Extrusion, Montmorency, France) nitinol flexible self-expanding stent for the treatment of progressive cerebrovascular accident or crescendo TIAs.
Methods:
Twelve patients, presenting with a clinical picture of a crescendo TIA or progressive stroke in evolution not halted by optimal medical care, were treated. Patients had a corresponding major cerebral arterial narrowing and evidence of cerebral infarction on imaging. Patients were followed clinically and radiographically.
Results:
Twelve patients 17 to 80 years of age were treated during the study period (20 months). Sixteen nitinol flexible self-expandable stents (LEO +) were placed. All patients showed moderate to substantial improvement in neurologic functions after the procedure.
Conclusion:
PTAS should be considered a treatment option in case of progressive stroke or crescendo TIAs coupled with appropriate anatomical findings. This may allow for a substantial improvement in functional and neurologic status.
