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.