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Updated: Jan 22, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Early versus delayed stenting for intracranial atherosclerotic artery stenosis with ischemic stroke
Yong Zhang1, Yujie Sun1, Xin Li1
1Department of Neurology and Interventional Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Insights
Early intracranial stenting (≤14 days) for stroke may increase long-term risks of cerebral vascular events and restenosis compared to late stenting (>14 days). This finding is crucial for managing intracranial artery stenosis.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Intracranial atherosclerotic stenosis is a significant cause of ischemic stroke.
- Optimal timing for intracranial stent placement remains debated.
- This study addresses the clinical outcomes of early versus late stenting.
Purpose of the Study:
- To compare clinical outcomes between early (≤14 days) and late (>14 days) intracranial stenting.
- To evaluate risks of cerebral vascular events and restenosis after stenting.
- To inform treatment guidelines for stroke due to intracranial artery stenosis.
Main Methods:
- Retrospective analysis of 115 patients with ischemic stroke and severe intracranial stenosis.
- Comparison of early stenting group (≤14 days) versus late stenting group (>14 days).
- Evaluation of procedural complications, restenosis, ischemic stroke recurrence, and mortality.
Main Results:
- Early stenting showed a trend towards higher early procedural complications (p=0.184).
- Long-term follow-up revealed significantly higher restenosis rates in the early group (p=0.018).
- The early stenting group experienced higher overall rates of ischemic stroke, TIA, hemorrhagic stroke, and death (p=0.035), including recurrent ischemic stroke (p=0.041).
Conclusions:
- Intracranial stenting within 14 days of ischemic stroke may increase long-term risks.
- Late stenting (>14 days) appears associated with better long-term outcomes and lower restenosis rates.
- Timing of intervention is a critical factor in managing intracranial artery stenosis.
Objective:
To evaluate the clinical outcomes of early stenting (≤14 days) or late stenting (>14 days) in patients who underwent intracranial stent placement.
Methods:
Patients with ischemic stroke caused by 70-99% intracranial atherosclerotic stenosis combined with poor collaterals were enrolled. The early stenting group, who underwent stenting within 14 days of last ischemic symptoms, were compared with the late stenting group who underwent stenting >14 days from last ischemic symptom. The patients were treated either with a balloon-mounted stent or a self-expanding stent as determined by the operators following a guideline. The baseline characteristics and clinical outcomes were evaluated and compared.
Results:
One hundred and fifteen stroke patients were recruited into the study. Four patients (4/41) in the early stenting group and two patients (2/74) in the late stenting group were diagnosed with a cerebral vascular event associated with stenting within 3 days (p=0.184). In the long-term follow-up, eight patients in the early stenting group had restenosis ≥50%, which was higher than patients in the late stenting group (8/41 vs 4/74, p=0.018). The total rates of any ischemic stroke, transient ischemic attack, hemorrhagic stroke, and death in the early stenting group were higher than in the late stenting group (9/41 vs 6/74, p=0.035). The recurrence rate of ischemic stroke in the early stenting group was higher than in the late stenting group (5/41 vs 2/74, p=0.041).
Conclusions:
Stent placement in the setting of ischemic stroke caused by intracranial artery stenosis within 14 days may confer a higher risk of long-time cerebral vascular events and lead to a higher risk of restenosis.
Clinical Trial Registration:
NCT01968122.
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