Background Balloon mounted (BMS) and drug-eluting stents (DES) have been used for ICAD with variable success. In this study, we report on our institutional experience with BMS/DES for treatment of ICAD.

Methods 27 patients with ICAD that underwent treatment with BMS, DES and Wingspan stents at Tufts Medical Center between November 2005–May 2022 were included in this retrospective study. Baseline patient and lesion characteristics were collected. Primary outcomes were periprocedural complications and occurrence of TIA/ischemic or hemorrhagic stroke, death within 72 hours. Secondary outcomes were occurrence of TIA/ischemic stroke and hemorrhagic stroke, death and MRS at long term follow up. Percent stenosis was evaluated immediately post-procedure and on follow-up imaging.

Results Mean±SD age was 62.8±9.0 years.25.9% were female. Stroke risk factors included hypertension (88.9%), hyperlipidemia (70.4%), diabetes mellitus (59.3%). Of the 27 treated patients, 26 received 27 stents. Procedure was aborted for 1 patient due to tortuous anatomy. Treated artery was in anterior circulation in 57% and posterior circulation in 43%. Four patients who received stents were treated emergently for acute stroke with thrombectomy and/or IV/IA tPA within 24 hours of presentation and 22 patients received stents in non-emergent fashion. SAH/IVH was seen in DES group in the setting of IV/IA tPA in the emergently treated group. In non-emergent settings, no patients developed TIA/ischemic stroke or hemorrhagic stroke within 72 hours of BMS and Wingspan placement, and 16.6% of patients had clinically silent punctate stroke on MRI and 8.3% of patients had asymptomatic small SAH in DES group. In long-term follow up, 14.3% had one TIA and 14.3% had recurrent TIA in BMS group,7.1% had TIA and ischemic stroke in DES group, and 33.3% had TIA in Wingspan group. Median MRS at follow up was 0 (IQR 0-0) for BMS, DES and Wingspan groups. Median precent stenosis before stent placement was 73% for BMS group, 77% for DES group, 71% for Wingspan group. Median residual percent stenosis immediately after stent placement was 15% for BMS group, 23% for DES group and 29% for Wingspan group. On follow-up imaging, median stenosis was 34% in BMS, 18% in DES, and 51% for Wingspan. Percent stenosis was lowest in DES group compared to both Wingspan and BMS groups at follow up (p=0.02 and p=0.05 respectively). Wingspan had lowest patency rate compared to BMS and DES groups (p=0.03), and one of patients in Wingspan group had a completely occluded stent at 7 years post-procedure. In-stent restenosis was less frequently seen in DES group compared to BMS and Wingspan groups (16.7% vs 42.9% and 66.7% respectively).

Conclusion DES appears effective and relatively safe with good long-term outcomes in treating intracranial atherosclerosis and secondary stroke prevention and is associated with lower delayed in-stent stenosis on follow up imaging compared to BMS and Wingspan stents. Use of DES for symptomatic ICAD in acute and non-emergent settings warrants further investigation.

Balloon mounted stent, drug eluting stent, Wingspan, intracranial atherosclerotic disease, outcomes.

Disclosures N. Turan: None. A. Malek: 2; C; CereVasc Inc.. 4; C; CereVasc Inc.