Introduction Angioplasty and stenting for intracranial atherosclerotic disease can re-establish adequate luminal diameter in highly stenotic arteries and improve cerebral blood flow. As in other vascular territories, intracranial stented arteries may develop delayed re-stenosis due to progression of atherosclerotic disease or endothelial hyperplasia. The primary strategies for management of re-stenosis have included aggressive medical therapy, angioplasty only, and repeat angioplasty and stenting.
Methods A total of 243 patients underwent intracranial angioplasty and stenting for symptomatic ICAD from 2000–2019 at two institutions. Patients were treated with balloon expandable coronary stents until 2002, when self-expanding intracranial nitinol stents became available. The series included: 21 balloon expandable coronary stents, 36 Neuroform or Atlas stents, 45 Enterprise stents, and 141 Wingspan stents. Of this group, 221 patients had delayed follow up intracranial vascular imaging at 6 months, 1 year, or longer. In follow up, 25 of the 221 patients (11.3%) developed significant re-stenosis, defined as 70% or greater. Eleven of the patients were symptomatic and 14 had no symptoms. A total of 17 patients underwent endovascular treatment of their re-stenosis, and 8 had medical management only.
Results The mean time interval for re-stenosis was 8.7 months. Of the 17 patients treated with endovascular therapy for re-stenosis, 4 patients had angioplasty only and 13 patients had angioplasty and stenting. There was one peri-procedural stroke in this group (5.9%) and no other strokes in the follow up period (mean 2.4 years, range 6 months – 7 years). Of the 8 patients who were managed medically, 1 patient had a stroke (12.5%) in the follow up period at 10 months (mean follow up 2.1 years, range 3 months – 5 years).
Discussion The preliminary data from this study suggests that patients with severe re-stenosis may be at significant risk of stroke, even if the re-stenosis is currently asymptomatic. As with other vascular territories, re-stenosis can be managed with multiple modalities, but repeat angioplasty and stenting in this series appears to be a low risk and viable option for these patients compared with medical therapy alone.
Disclosures M. Alexander: 2; C; Stryker Neurovascular. Z. Barnard: None.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.