Stenting in Intracranial Stenosis: Current Controversies and Future Directions

Abstract Angioplasty and stenting for intracranial atherosclerotic stenosis (ICAS) are a last resort for patients with high-grade intracranial stenosis with multiple ischemic events unresponsive to medical therapy. Medical management, consisting of aggressive risk factor control and dual antiplatelet therapy, is superior to angioplasty and stenting for the prevention of future stroke. Future studies of angioplasty and stenting in this population are important, as the stroke risk on medical therapy is 12 % at 1 year and post-procedure stroke rates are similar to rates with medical treatment. There are many issues that will need to be resolved for stenting to offer any benefit, however. Procedural risks of hemorrhagic and ischemic stroke are unacceptably high. High-risk subgroups, potentially based on hemodynamic factors, will need to be identified for future interventional trials. Nevertheless, it is still reasonable to consider angioplasty and stenting for selected patients with multiple recurrent events despite aggressive medical management, but benefits are unclear at this time.
Source: Current Atherosclerosis Reports - Category: Cardiology Source Type: research

Related Links:

Publication date: Available online 1 September 2019Source: The LancetAuthor(s): Deepak L Bhatt, Philippe Gabriel Steg, Shamir R Mehta, Lawrence A Leiter, Tabassome Simon, Kim Fox, Claes Held, Marielle Andersson, Anders Himmelmann, Wilhelm Ridderstråle, Jersey Chen, Yang Song, Rafael Diaz, Shinya Goto, Stefan K James, Kausik K Ray, Alexander N Parkhomenko, Mikhail N Kosiborod, Darren K McGuire, Robert A HarringtonSummaryBackgroundPatients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic even...
Source: The Lancet - Category: General Medicine Source Type: research
ConclusionsIn patients with AF undergoing PCI at lower ischemic risk and higher bleeding risk, 1 month of TT seems safe and efficacious. Further studies are warranted in patients at high ischemic risk.
Source: Cardiovascular Drugs and Therapy - Category: Cardiology Source Type: research
CONCLUSIONS: The single-cross technique appears to be a safe and effective option for treating tandem occlusive lesions in the setting of ELVO. PMID: 31311374 [PubMed - as supplied by publisher]
Source: Interventional Neuroradiology - Category: Radiology Tags: Interv Neuroradiol Source Type: research
Authors: Wang X, Yang B, Zhu H, Jiao L Abstract Contrast extravasation is a common phenomenon in acute ischaemic stroke patients who are treated with endovascular therapy, but it is rarely reported in selective angioplasty of intracranial artery stenosis. In this case we present the treatment and follow-up studies of a patient with severe stenosis in the M1 segment of the middle cerebral artery. We observed extravasation of contrast medium in the brain tissue around the stent after the operation by a computed tomography scan taken immediately, but the patient did not experience any neurological deficits during the ...
Source: Interventional Neuroradiology - Category: Radiology Tags: Interv Neuroradiol Source Type: research
CONCLUSION: The use of tirofiban before MT can shorten the procedure time and improve the recanalization rate of occluded vessels in AIS patients. PMID: 31112428 [PubMed - as supplied by publisher]
Source: Interventional Neuroradiology - Category: Radiology Tags: Interv Neuroradiol Source Type: research
Conclusions: Angioplasty and stenting may be feasible for the patients with nonacute symptomatic atherosclerotic middle cerebral artery total occlusive disease who have failed medical management.
Source: Frontiers in Neurology - Category: Neurology Source Type: research
We report two cases of patients with AMI complicating ischemic stroke, successfully treated with cangrelor infusion, which was started during PCI and maintained up to 48 h at bridge therapy dosage (0.75 mcg/kg/min). Both patients underwent successful PCI in the acute phase, and neither ischemic nor hemorrhagic complications occurred during in-hospital stay. PMID: 31066332 [PubMed - as supplied by publisher]
Source: Platelets - Category: Hematology Tags: Platelets Source Type: research
CONCLUSION: In this retrospective single-center study undersized balloon angioplasty and deployment of a self-expandable stent with relatively low radial force was safe and effective for endovascular treatment of high-grade intracranial arterial stenosis with high technical success rate, low periprocedural complication rates and favorable medium-term follow-up results. PMID: 30991867 [PubMed - as supplied by publisher]
Source: Interventional Neuroradiology - Category: Radiology Tags: Interv Neuroradiol Source Type: research
Jang-Hyun Baek1 and Byung Moon Kim2* 1Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea 2Department of Radiology, Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea Identification of intracranial, atherosclerosis-related, large vessel occlusion (ICAS-LVO) is important to set up an optimal endovascular treatment strategy, as most ICAS-LVOs require specific endovascular modalities for efficient recanalization. However, there is currently no decisive way to identify ICAS...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Publication date: Available online 6 March 2019Source: Journal of Clinical NeuroscienceAuthor(s): Yu Zhou, Li Wang, Jian-Rong Zhang, Kai Zhou, Jie Shuai, Zi-Li Gong, Yong Liu, Fei Wei, Yu-Fu Han, Lin Shen, Qing-Wu YangAbstractThis retrospective study is to investigate the safety and efficacy of the stent implanting for treating severe symptomatic atherosclerotic stenosis of the intracranial vertebrobasilar artery (ICVBA). 213 patients who had undergone intervention for severe symptomatic ICVBA stenosis between September 2012 to May 2018 were enrolled into this study. Among the 213 enrolled patients, 210 patients (98.6%) ob...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
More News: Angioplasty | Cardiology | Hemorrhagic Stroke | Ischemic Stroke | Stroke | Study