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Original research
Outcomes of tailored angioplasty and/or stenting for symptomatic intracranial atherosclerosis: a prospective cohort study after SAMMPRIS
  1. Zhongrong Miao1,
  2. Ligang Song1,
  3. David S Liebeskind3,
  4. Liping Liu2,
  5. Ning Ma1,
  6. Yilong Wang2,
  7. Dapeng Mo1,
  8. Feng Gao1,
  9. Xingquan Zhao2,
  10. Kehui Dong2,
  11. Dong Zhang4,
  12. Peiyi Gao5
  1. 1Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2Departments of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  3. 3Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA
  4. 4Departments of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  5. 5Departments of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Professor Z Miao, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing 100050, China; zhongrongm{at}163.com

Abstract

Background and purpose High periprocedural complication rate is a key limitation of endovascular treatment of intracranial atherosclerotic disease (ICAD), despite potential risk reduction of recurrent stroke. Taking lessons from the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Arterial Stenosis (SAMMPRIS) trial, targeting a selected patient population, we prospectively evaluated the feasibility and safety of tailored angioplasty and/or stenting for patients with ICAD.

Methods From November 2011 to October 2012, 158 patients with symptomatic ICAD caused by hypoperfusion combined with poor collateral flow were consecutively recruited into a prospective single center study. Patients were divided into three groups based on arterial access and lesion morphology: balloon mounted stent group (group BS) for smooth access and Mori A lesion, angioplasty plus self-expanding stent group (group AS) for tortuous access and Mori B or C lesion, and angioplasty group (group AG) for tortuous access and Mori A lesion. The primary endpoints were successful procedure rate and any vascular event within 30 days.

Results Overall technical success rate was 96.3% (154/158). There were significant differences in the technical success rate: 89.7% (35/39) in group AG compared with 97.5% (79/81) in group BS and 100% (38/38) in group AS (p=0.042). The 30 day composite stroke, myocardial infarction, or death rate was 4.4% (7/158). Stroke within 30 days occurred in four patients in group BS and in three patients in group AS.

Conclusions Individualized treatment of ICAD using tailored devices according to arterial access and lesion morphology was feasible and safe in symptomatic patients caused by hypoperfusion with poor collateral flow.

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