Outcomes of tailored angioplasty and/or stenting for symptomatic intracranial atherosclerosis: a prospective cohort study after SAMMPRIS.
OBJECTIVE
High periprocedural complication rate is a key limitation of endovascular treatment of intracranial atherosclerotic disease (ICAD), despite potential risk reduction of recurrent stroke. Taking lessons from the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Arterial Stenosis (SAMMPRIS) trial, targeting a selected patient population, we prospectively evaluated the feasibility and safety of tailored angioplasty and/or stenting for patients with ICAD.


METHODS
From November 2011 to October 2012, 158 patients with symptomatic ICAD caused by hypoperfusion combined with poor collateral flow were consecutively recruited into a prospective single center study. Patients were divided into three groups based on arterial access and lesion morphology: balloon mounted stent group (group BS) for smooth access and Mori A lesion, angioplasty plus self-expanding stent group (group AS) for tortuous access and Mori B or C lesion, and angioplasty group (group AG) for tortuous access and Mori A lesion. The primary endpoints were successful procedure rate and any vascular event within 30 days.


RESULTS
Overall technical success rate was 96.3% (154/158). There were significant differences in the technical success rate: 89.7% (35/39) in group AG compared with 97.5% (79/81) in group BS and 100% (38/38) in group AS (p=0.042). The 30 day composite stroke, myocardial infarction, or death rate was 4.4% (7/158). Stroke within 30 days occurred in four patients in group BS and in three patients in group AS.


CONCLUSIONS
Individualized treatment of ICAD using tailored devices according to arterial access and lesion morphology was feasible and safe in symptomatic patients caused by hypoperfusion with poor collateral flow.
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Zhongrong
Z
Miao
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ligang
L
Song
Department of Neurology, UCLA Stroke Center, Los Angeles, California, USA.
David S
DS
Liebeskind
Departments of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Liping
L
Liu
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ning
N
Ma
Departments of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Yilong
Y
Wang
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Dapeng
D
Mo
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Feng
F
Gao
Departments of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Xingquan
X
Zhao
Departments of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Kehui
K
Dong
Departments of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Dong
D
Zhang
Departments of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Peiyi
P
Gao
D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D002986:Clinical Trials as Topic; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology
Angioplasty; Atherosclerosis; Balloon; Stenosis; Stent