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Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis
1From the Department of Neurosurgery (P.G., F.Z., L.J., X.J., F.L.), Xuanwu Hospital, Capital Medical University, Beijing, China.
Insights
Modified intracranial stent placement significantly reduced stroke and/or death rates. This prospective study in China shows improved safety for patients with intracranial stenosis.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- High rates of stroke and/or death (14.7%) were observed with previous intracranial stent placement.
- Modifications in patient selection and procedural techniques were recommended to improve outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of modified intracranial stent placement.
- To determine if revised protocols lower periprocedural stroke and/or death rates.
Main Methods:
- A prospective, single-arm, multicenter trial was conducted in China.
- 100 patients with high-grade intracranial stenosis (70%-99%) were enrolled.
- Angioplasty and self-expanding stents were used within 3 weeks of the ischemic event.
Main Results:
- The technical success rate for stent deployment was 100%, achieving <50% residual stenosis.
- The 1-month stroke and/or death rate was significantly reduced to 2% (95% CI, 0.2%-7.0%).
- Two ischemic strokes occurred in perforator distributions after basilar artery stenting.
Conclusions:
- Modified patient selection and procedural techniques substantially decrease the risk of stroke and/or death after intracranial stent placement.
- This approach offers a safer option for managing intracranial stenosis.
Background And Purpose:
On the basis of the high 1-month stroke and/or death (14.7%) rates associated with stent placement in the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial, modifications in patient selection and procedural aspects for intracranial stent placement have been recommended. We performed a multicenter prospective single-arm trial to determine whether such modifications would result in lower rates of periprocedural stroke and/or death.
Materials And Methods:
The study enrolled patients with recent transient ischemic attack or ischemic stroke (excluding perforator ischemic events) related to high-grade (70%-99% in severity) stenosis of a major intracranial artery. Patients were treated by using angioplasty and self-expanding stents 3 weeks after the index ischemic event at 1 of the 10 high-volume centers in China. An independent neurologist ascertained the occurrence of any stroke and/or death within 1 month after the procedure.
Results:
A total of 100 consecutive patients were recruited. The target lesions were located in the middle cerebral artery (M1) (n = 38, 38%), intracranial internal carotid artery (n = 17, 17%), intradural vertebral artery (n = 18, 18%), and basilar artery (n = 27, 27%). The technical success rate of stent deployment with residual stenosis of <50% was 100%. The overall 1-month stroke and/or death rate was 2% (95% confidence interval, 0.2%-7.0%). Two ischemic strokes occurred in the pontine region (perforator distribution) in patients following angioplasty and stent placement for basilar artery stenosis.
Conclusions:
The results of this prospective multicenter study demonstrated that modifications in patient selection and procedural aspects can substantially reduce the 1-month stroke and/or death rate following intracranial stent placement.
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