Intracranial stenting for severe symptomatic stenosis: self-expandable versus balloon-expandable stents.
Intracranial atherosclerosis against optimal medical treatment requires reperfusion therapy to improve the clinical outcome. We compared outcomes between self-expandable stent (SES) and/or balloon-expandable stent (BES) and present the potential advantages of using each stent. During the same time frame before and after Wingspan introduction to our institute, 115 consecutive patients underwent intracranial stenting for symptomatic severe intracranial stenosis against optimal medical treatment using BES alone (n = 71) vs. BES or SES (n = 44). We analyzed 15 factors including outcome related to an adverse event (AE), modified Rankin Scale (mRS) and restenosis at six months and retrospectively compared the potential advantages of using each stent. BES or SES groups had a significantly lower AE rate (2.3%) than the BES only group (14%) (P = 0.049) revealing mRS of ≤ 2 in all patients at six months compared to 93% of the patients in the BES group. Analysis of BES or SES subgroups revealed that BES was associated with less residual stenosis after stenting than SES (18 vs. 32%; P < 0.001). Both SES and BES can improve the clinical outcome of intracranial stenting especially with a selective choice of SES or BES. Further study is needed to analyse the difference in long-term outcome and the restenosis rate between SES and BES.
Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center; Songpa-gu, Seoul, Korea - E-mail: dcsuh@amc.seoul.kr.
Soonchan
S
Park
Jae-Hyuk
JH
Kim
Jae Kyun
JK
Kwak
Hye Jin
HJ
Baek
Bo Hyun
BH
Kim
Dong-Geun
DG
Lee
Deok Hee
DH
Lee
Jong Sung
JS
Kim
Dae Chul
DC
Suh
D000800:Angioplasty, Balloon / Q000295:instrumentation* / Q000401:mortality*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D003251:Constriction, Pathologic / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D011474:Prosthesis Design; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome