Stenting for symptomatic intracranial arterial stenosis in China: 1-year outcome of a multicentre registry study

Abstract

Background and purpose: A multicentre prospective registry study of individually tailored stenting for a patient with symptomatic intracranial atherosclerotic stenosis (ICAS) combined with poor collaterals in China showed that the short-term safety and efficacy of stenting was acceptable. However, it remained uncertain whether the low event rate could be of a long term. We reported the 1-year outcome of this registry study to evaluate the long-term efficacy of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals.

Methods: Patients with symptomatic ICAS caused by 70%-99% stenosis located at the intracranial internal carotid, middle cerebral, intracranial vertebral or basilar arteries combined with poor collaterals were enrolled. Balloon-mounted stent or balloon plus self-expanding stent were selected based on the ease of vascular access and lesion morphology determined by the operators. The primary outcome was the rate of 30-day stroke, transient ischaemic attack and death, and 12-month ischaemic stroke within the same vascular territory, haemorrhagic stroke and vascular death after stenting.

Results: From September 2013 to January 2015, 300 patients (ages 58.3±9.78 years) were recruited. Among them, 159 patients were treated with balloon-mounted stent and 141 with balloon plus self-expanding stent. During the 1-year follow-up, 25 patients had a primary end point event. The probability of primary outcome at 1 year was 8.1% (95% CI 5.3% to 11.7%). In 76 patients with digital subtraction angiography follow-up, 27.6% (21/76) had re-stenosis ≥50% and 18.4% (14/76) had re-stenosis ≥70%. No baseline characteristic was associated with the primary outcome.

Conclusion: The event rate remains low over 1 year of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals. Further randomised trial of comparing individually tailored stenting with best medical therapy is needed.

Trial registration number: NCT01968122; Results.

Keywords: angioplasty and stenting; atherosclerosis; intracranial stenosis.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Flow chart of participants.

Figure 2

A 66-year-old male patient with symptomatic left intracranial carotid artery stenosis treated with balloon-mounted stenting. (A) CT angiography showed severe left intracranial atherosclerotic stenosis. (B) CT perfusion showed obvious hypoperfusion of the left hemisphere compared with that of the right hemishphere. (C) The lesion was treated with a balloon-mounted stent (2.5 mm × 8 mm). The degree of stenosis decreased from 85% to 0%. CBF, cerebral blood flow; CBV, cerebral blood volume; MTT, mean transit time; TTP, time to peak.

Figure 3

A 44-year-old male patient with symptomatic left intracranial vertebral artery stenosis treated with balloon predilation plus self-expanding stenting. (A) CT angiography showed a severe left intracranial vertebral artery stenosis. (B) CT perfusion showed hypoperfusion in the posterior circulation territory compared with that in the anterior circulation territory. (C) The lesion was treated with a balloon (2.5 mm × 15 mm) and then implantation of a self-expanding stent (3.0 mm × 20 mm). The degree of stenosis decreased from 90% to 0%. CBF, cerebral blood flow; CBV, cerebral blood volume; MTT, mean transit time; TTP, time to peak.

Figure 4

Cumulative probability of a primary outcome.