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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Angioplasty And stenting For symptomatic intracranial atherosclerotic disease: How I Do It

Ermias A Mekonnen1, Wondwossen G Tekle1,2, Sohum K Desai1,2

  • 1Department of Neuroscience, Valley Baptist Medical Center, Harlingen, TX, USA.

Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences
|March 25, 2022
PubMed

Insights

Intracranial atherosclerotic disease (ICAD) causes recurrent strokes. Recent studies show Balloon-mounted stents (BMS) offer a safer endovascular treatment option for symptomatic ICAD, with lower complication rates than previous trials.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Interventional Cardiology

Background:

  • Intracranial atherosclerotic disease (ICAD) is a significant cause of ischemic stroke.
  • High rates of recurrent stroke occur despite optimal medical management.
  • Endovascular treatment for ICAD remains controversial due to historical complication rates.

Purpose of the Study:

  • To review the recent advancements in endovascular therapy for symptomatic ICAD.
  • To evaluate the safety and efficacy of newer endovascular techniques.

Main Methods:

  • Review of recent multicenter prospective studies on stent placement for ICAD.
  • Comparison of periprocedural complication rates with historical trials (SAMMPRIS, VISSIT).
  • Focus on Balloon-mounted stents (BMS) in symptomatic high-grade intracranial stenosis.

Main Results:

  • A recent prospective study demonstrated significantly lower periprocedural stroke rates (5.6%) with BMS compared to historical trials (SAMMPRIS: 14.7%, VISSIT: 21.4%).
  • This suggests improved safety profiles for contemporary endovascular approaches.
  • Balloon-mounted stents show promise in managing symptomatic ICAD.

Conclusions:

  • Endovascular therapy for symptomatic ICAD has evolved, offering improved safety.
  • Balloon-mounted stents represent a viable and potentially safer option for selected ICAD patients.
  • Further research and clinical adoption of refined endovascular techniques are warranted.

Keywords:
Intracranial atherosclerosis diseasein-stent stenosisintracranial angioplastyintracranial stentingischemic stroke

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