P Gao1, D Wang2, Z Zhao3, Y Cai4, T Li5, H Shi6, W Wu7, W He8, L Yin9, S Huang10, F Zhu1, L Jiao11, X Ji1, A I Qureshi12, F Ling1. 1. From the Department of Neurosurgery (P.G., F.Z., L.J., X.J., F.L.), Xuanwu Hospital, Capital Medical University, Beijing, China. 2. Department of Neurosurgery (D.W.), Beijing Hospital of the Ministry of Health, Beijing, China. 3. Department of Neurosurgery (Z.Z.), Tangdu Hospital, the Fourth Military Medical University, Xi'an, Shaanxi Province, China. 4. Department of Neurology (Y.C.), the 306 Hospital of the People's Liberation Army, Beijing, China. 5. Department of Intervention (T.L.), Henan Provincial People's Hospital, Zhengzhou, Henan Province, China. 6. Department of Neurosurgery (H.S.), the 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China. 7. Department of Neurology (W.W.), Qilu Hospital of Shandong University, Ji'nan, Shandong Province, China. 8. Department of Neurosurgery (W.H.), the 2nd Affiliated Hospital of Guangzhou Medical College, Guangzhou, Guangdong Province, China. 9. Department of Neurosurgery (L.Y.), Tianjin Huanhu Hospital, Tianjin, China. 10. Department of Neurosurgery (S.H.), Guangdong Province Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China. 11. From the Department of Neurosurgery (P.G., F.Z., L.J., X.J., F.L.), Xuanwu Hospital, Capital Medical University, Beijing, China liqunjiao@sina.cn. 12. Zeenat Qureshi Stroke Institute (A.I.Q.), St. Cloud, Minnesota.
Abstract
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.
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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