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Stenting for intracranial stenosis: potential future for the prevention of disabling or fatal stroke

Wengui Yu1, Wei-Jian Jiang2

  • 1Department of Neurology, University of California, Irvine, California, USA.

Stroke and Vascular Neurology
|October 9, 2018
PubMed

Insights

Intracranial stenting for stroke prevention showed higher risks initially. However, reduced periprocedural complications in newer trials suggest a potential benefit for preventing disabling strokes.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Interventional Neurology

Background:

  • Intracranial stenosis is a significant cause of ischemic strokes, particularly in Asian, African, and Hispanic populations.
  • Previous studies like SAMMPRIS indicated higher risks with stenting compared to medical management due to periprocedural complications.

Purpose of the Study:

  • To re-evaluate the role of intracranial stenting in preventing disabling or fatal strokes.
  • To assess if recent advancements in reducing periprocedural complications alter the risk-benefit profile of stenting.

Main Methods:

  • Review of randomized controlled trials and post-market surveillance studies on intracranial stenting for symptomatic severe intracranial stenosis.
  • Comparison of periprocedural complication rates and long-term stroke outcomes between stenting and aggressive medical management.

Main Results:

  • The SAMMPRIS trial showed higher rates of stroke or death within 30 days for stenting (14.7%) versus medical management (5.8%).
  • Periprocedural complications in the stenting group of SAMMPRIS were a major contributor to early adverse events (7.1% vs 1.8%).
  • More recent trials (Chinese Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis, WEAVE) reported significantly lower periprocedural complication rates (2%-2.7%).

Conclusions:

  • While early studies suggested medical management superiority due to high periprocedural risks, newer data indicate potential benefits of stenting.
  • Reducing periprocedural complications is key to realizing the potential benefit of intracranial stenting for preventing long-term disabling or fatal strokes.

Keywords:
complicationintracranial stenosisstentingstroke prevention

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