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Intracranial stenting for large vessel intracranial atherosclerotic disease: Retrospective study
Jonathan Naftali1, Michael Findler1,2,3, Alain Perlow2,3
1Department of Neurology, Rabin Medical Center, Petach Tikva, Israel.
Insights
Intracranial stenting (ICS) for intracranial atherosclerotic disease (ICAD) shows promise, especially elective ICS, despite risks. New devices may improve outcomes for stroke prevention when medical therapy fails.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Intracranial atherosclerotic disease (ICAD) is a significant cause of stroke.
- Current guidelines advise against intracranial stenting (ICS) for ICAD.
- Treatment for ICAD patients refractory to medical therapy remains debated.
Purpose of the Study:
- To analyze the outcomes of intracranial stenting (ICS) in patients with ICAD.
- To evaluate ICS in both acute and elective settings.
- To assess stroke, functional outcomes, and adverse events post-ICS.
Main Methods:
- Retrospective analysis of patients treated with ICS from 2018-2022.
- Inclusion of patients treated in acute phase or electively (eICS).
- Endpoints included stroke, modified Rankin Scale (mRS) at 3 months, and serious adverse events.
Main Results:
- 33 stents implanted (21 acute, 12 eICS); 75% used new-generation self-expandable stents.
- Peri-procedural stroke occurred in 1 patient; 4 had follow-up TIAs or strokes.
- 15 patients (62%) achieved favorable outcomes (mRS 0-2); 100% of eICS patients with pre-stroke mRS 0-2 had favorable outcomes.
Conclusions:
- Advancements in ICS devices and experience may herald a new era for ICAD treatment.
- ICS remains a practice in tertiary centers for refractory ICAD cases due to lack of alternatives.
- Elective ICS shows potential for favorable outcomes in selected ICAD patients.
Abstract:
BackgroundIntracranial atherosclerotic disease (ICAD) is a common cause for stroke and can be defined as symptomatic (stroke) or asymptomatic. Current guidelines recommend against intracranial stenting (ICS) for patients with ICAD; treatment of patients who failed the best medical therapy is still debatable.MethodsWe introduce a preliminary retrospective analysis of our tertiary stroke center during 2018-2022 of patients that were treated with ICS either in acute phase or elective (eICS). Study endpoints were stroke, functional outcome (modified Rankin Score [mRS] at 3 months), and serious adverse events.ResultsThirty-three stents were implanted, 21 in acute group and 12 in the eICS group. Most patients (75%) were treated with a new generation self-expandible stent. One patient had peri-procedural stroke and four patients had transient ischemic event or stroke during follow-up. There were eight cases of death (all acute group patients, seven of which occurred in the posterior circulation). Fifteen patients (62%) had favorable clinical outcomes (mRS 0-2 for pre-stroke), of which 10/10 (100%) in the eICS, the other two eICS patients had pre-morbid mRS 3 with no clinical change.ConclusionsThe evolution of new devices for ICS and the accumulating interventional experience might open a new era. As no other effective alternative treatment options exist for preventing recurrent stroke, stenting is still common practice in many tertiary centers either urgently or as elective procedure for refractory cases.
