Multicenter analysis of stenting in symptomatic intracranial atherosclerosis

Wei Jian Jiang, Esteban Cheng-Ching, Alex Abou-Chebl, Osama O. Zaidat, Tudor G. Jovin, Junaid Kalia, Muhammad Shazam Hussain, Ridwan Lin, Amer Malik, Ferdinand Hui, Rishi Gupta

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Stenting for symptomatic intracranial atherosclerotic disease is a therapeutic option in patients in whom medical therapy fails. OBJECTIVE: To determine the periprocedural complication rates and mid-term restenosis rates in patients treated with balloon-expandable stents (BESs) compared with selfexpanding stents (SESs). METHODS: A retrospective review of consecutive patients treated with intracranial stents at 5 institutions was performed. Predictors of 30-day stroke and death as well as mid-term restenosis rates were analyzed. RESULTS: A total of 670 lesions were treated in 637 patients with a mean age of 57 ± 13 years. A total of 454 lesions (68%) were treated with BESs and 216 lesions (32%) with SESs. The overall 30-day periprocedural complication rate was 6.1%, without any difference noted between the 2 groups. Patients treated within 24 hours of the index event were significantly more likely to have experienced a periprocedural complication (odds ratio [OR], 4.0; 95% confidence interval [CI]: 1.7-6.7; P, <007), whereas focal lesions were less likely to have a complication (OR, 0.31; 95% CI: 0.13-0.72; P, <001). Midterm restenosis was less likely in patients with a lower percentage of posttreatment stenosis (OR, 0.97; 95% CI: 0.95-0.99; P, <006), which was more common in BES-treated patients and focal concentric lesions (OR, 0.33; 95% CI: 0.23-0.55; P, <0001). CONCLUSION: BESs have periprocedural complication rates similar to those of SESs. Less posttreatment stenosis was associated with lower rates of mid-term restenosis. Future randomized trials comparing BESs and SESs may help to identify the stent type that is safest and most durable.

Original languageEnglish (US)
Pages (from-to)25-30
Number of pages6
JournalNeurosurgery
Volume70
Issue number1
DOIs
StatePublished - Jan 2012
Externally publishedYes

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Intracranial Arteriosclerosis
Stents
Odds Ratio
Confidence Intervals
Pathologic Constriction

Keywords

  • Angioplasty
  • Intracranial stenosis
  • Intracranial stenting
  • Ischemic stroke
  • Stent

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Jiang, W. J., Cheng-Ching, E., Abou-Chebl, A., Zaidat, O. O., Jovin, T. G., Kalia, J., ... Gupta, R. (2012). Multicenter analysis of stenting in symptomatic intracranial atherosclerosis. Neurosurgery, 70(1), 25-30. https://doi.org/10.1227/NEU.0b013e31822d274d

Multicenter analysis of stenting in symptomatic intracranial atherosclerosis. / Jiang, Wei Jian; Cheng-Ching, Esteban; Abou-Chebl, Alex; Zaidat, Osama O.; Jovin, Tudor G.; Kalia, Junaid; Hussain, Muhammad Shazam; Lin, Ridwan; Malik, Amer; Hui, Ferdinand; Gupta, Rishi.

In: Neurosurgery, Vol. 70, No. 1, 01.2012, p. 25-30.

Research output: Contribution to journalArticle

Jiang, WJ, Cheng-Ching, E, Abou-Chebl, A, Zaidat, OO, Jovin, TG, Kalia, J, Hussain, MS, Lin, R, Malik, A, Hui, F & Gupta, R 2012, 'Multicenter analysis of stenting in symptomatic intracranial atherosclerosis', Neurosurgery, vol. 70, no. 1, pp. 25-30. https://doi.org/10.1227/NEU.0b013e31822d274d
Jiang WJ, Cheng-Ching E, Abou-Chebl A, Zaidat OO, Jovin TG, Kalia J et al. Multicenter analysis of stenting in symptomatic intracranial atherosclerosis. Neurosurgery. 2012 Jan;70(1):25-30. https://doi.org/10.1227/NEU.0b013e31822d274d
Jiang, Wei Jian ; Cheng-Ching, Esteban ; Abou-Chebl, Alex ; Zaidat, Osama O. ; Jovin, Tudor G. ; Kalia, Junaid ; Hussain, Muhammad Shazam ; Lin, Ridwan ; Malik, Amer ; Hui, Ferdinand ; Gupta, Rishi. / Multicenter analysis of stenting in symptomatic intracranial atherosclerosis. In: Neurosurgery. 2012 ; Vol. 70, No. 1. pp. 25-30.
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AU - Cheng-Ching, Esteban

AU - Abou-Chebl, Alex

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AU - Jovin, Tudor G.

AU - Kalia, Junaid

AU - Hussain, Muhammad Shazam

AU - Lin, Ridwan

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N2 - BACKGROUND: Stenting for symptomatic intracranial atherosclerotic disease is a therapeutic option in patients in whom medical therapy fails. OBJECTIVE: To determine the periprocedural complication rates and mid-term restenosis rates in patients treated with balloon-expandable stents (BESs) compared with selfexpanding stents (SESs). METHODS: A retrospective review of consecutive patients treated with intracranial stents at 5 institutions was performed. Predictors of 30-day stroke and death as well as mid-term restenosis rates were analyzed. RESULTS: A total of 670 lesions were treated in 637 patients with a mean age of 57 ± 13 years. A total of 454 lesions (68%) were treated with BESs and 216 lesions (32%) with SESs. The overall 30-day periprocedural complication rate was 6.1%, without any difference noted between the 2 groups. Patients treated within 24 hours of the index event were significantly more likely to have experienced a periprocedural complication (odds ratio [OR], 4.0; 95% confidence interval [CI]: 1.7-6.7; P, <007), whereas focal lesions were less likely to have a complication (OR, 0.31; 95% CI: 0.13-0.72; P, <001). Midterm restenosis was less likely in patients with a lower percentage of posttreatment stenosis (OR, 0.97; 95% CI: 0.95-0.99; P, <006), which was more common in BES-treated patients and focal concentric lesions (OR, 0.33; 95% CI: 0.23-0.55; P, <0001). CONCLUSION: BESs have periprocedural complication rates similar to those of SESs. Less posttreatment stenosis was associated with lower rates of mid-term restenosis. Future randomized trials comparing BESs and SESs may help to identify the stent type that is safest and most durable.

AB - BACKGROUND: Stenting for symptomatic intracranial atherosclerotic disease is a therapeutic option in patients in whom medical therapy fails. OBJECTIVE: To determine the periprocedural complication rates and mid-term restenosis rates in patients treated with balloon-expandable stents (BESs) compared with selfexpanding stents (SESs). METHODS: A retrospective review of consecutive patients treated with intracranial stents at 5 institutions was performed. Predictors of 30-day stroke and death as well as mid-term restenosis rates were analyzed. RESULTS: A total of 670 lesions were treated in 637 patients with a mean age of 57 ± 13 years. A total of 454 lesions (68%) were treated with BESs and 216 lesions (32%) with SESs. The overall 30-day periprocedural complication rate was 6.1%, without any difference noted between the 2 groups. Patients treated within 24 hours of the index event were significantly more likely to have experienced a periprocedural complication (odds ratio [OR], 4.0; 95% confidence interval [CI]: 1.7-6.7; P, <007), whereas focal lesions were less likely to have a complication (OR, 0.31; 95% CI: 0.13-0.72; P, <001). Midterm restenosis was less likely in patients with a lower percentage of posttreatment stenosis (OR, 0.97; 95% CI: 0.95-0.99; P, <006), which was more common in BES-treated patients and focal concentric lesions (OR, 0.33; 95% CI: 0.23-0.55; P, <0001). CONCLUSION: BESs have periprocedural complication rates similar to those of SESs. Less posttreatment stenosis was associated with lower rates of mid-term restenosis. Future randomized trials comparing BESs and SESs may help to identify the stent type that is safest and most durable.

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KW - Intracranial stenosis

KW - Intracranial stenting

KW - Ischemic stroke

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