scholarly journals The New Standard for Performance of Intracranial Angioplasty and Stent Placement after Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) Trial

2011 ◽  
Vol 32 (11) ◽  
pp. E214-E214 ◽  
Author(s):  
S.A. Chaudhry ◽  
M. Watanabe ◽  
A.I. Qureshi
Keyword(s):  
Medical Therapy ◽  
Stent Placement ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis

The Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis Trial: Reanalysis Using the FDA “On Label” Criteria

2020 ◽  
Vol 30 (6) ◽  
pp. 857-861
Author(s):  
Adnan I. Qureshi ◽  
Muhammad F. Ishfaq ◽  
Vamshi K. S. Balasetti ◽  
Iryna Lobanova ◽  
Guven Uzun ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis

Abstract TP422: Comparison of Natural History and Effect of Intracranial Stent Placement Between Patients With Intra-Dural and Those With Sub-Arachnoid Intracranial Arterial Stenosis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sargun S Walia ◽  
Wei Huang ◽  
Iryna Lobanova ◽  
Farhan Siddiq ◽  
Brandi R French ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Stent Placement ◽  
Cerebral Hemorrhage ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Intracranial Stent ◽  
Subarachnoid Spaces

Background: Intracranial stenosis can be located in intradural or subarachnoid space. It is unclear whether there are any differences in ipsilateral ischemic stroke risk, cerebral hemorrhage and death in response to stent placement in these two locations. Methods: We analyzed Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) data. We divided the patients based on location of arterial stenosis: intradural [petrous internal carotid artery (ICA), pre-cavernous ICA, cavernous ICA or pre-posterior inferior cerebellar artery (PICA) vertebral artery] and subarachnoid [post-cavernous ICA, middle cerebral artery, vertebral artery at the level of or distal to origin of PICA, or basilar artery]. Cox proportional hazards analyses were used to determine the effect of intradural versus subarachnoid location on risk of ipsilateral ischemic stroke, cerebral hemorrhage or death during the follow-up period. Results: A total of 451 patients with stenosis located in intradural (n=74, 16.4%) or subarachnoid (n=377, 83.5 %) spaces were followed for a mean (SD) period of 29.06 (15.22) months after randomization. The rate of ischemic stroke seen in intradural and subarachnoid spaces was 11.86% and 14.58%, respectively. The rate of cerebral hemorrhage in the intradural and subarachnoid spaces was 1.35% and 2.92 %, respectively. The rate of death in the intradural and subarachnoid spaces was 10.81% and 1.59%, respectively. In Cox proportional hazards analyses, the risk of ipsilateral ischemic stroke (HR 1.08, P = 0.46), cerebral hemorrhage (HR 1.05, P = 0.59) and death (HR 0.9, P = 0.9) was not significantly different between patients with intradural arterial stenosis and those with subarachnoid arterial stenosis. The interaction between location of stenosis and treatment (intracranial stent versus best medical treatment) was not significant for the either ipsilateral ischemic stroke (p= 0.21), cerebral hemorrhage (p= 0.18) or death (p=0.15). Conclusion: We did not find any evidence to suggest that there was any difference in natural history or response to intracranial stent placement in patients with intradural location of stenosis compared with those with subarachnoid location.

scholarly journals Undersized angioplasty and stenting of symptomatic intracranial tight stenosis with Enterprise: Evaluation of clinical and vascular outcome

2015 ◽  
Vol 22 (2) ◽  
pp. 187-195 ◽  
Author(s):  
Kun-Yu Lee ◽  
David Yen-Ting Chen ◽  
Hui-Ling Hsu ◽  
Chi-Jen Chen ◽  
Ying-Chi Tseng
Keyword(s):  
Medical Therapy ◽  
Arterial Stenosis ◽  
Modified Rankin Scale ◽  
Intracranial Arterial Stenosis ◽  
Stent Deployment ◽  
Technical Success Rate ◽  
Stent Restenosis ◽  
Intracranial Atherosclerotic Disease ◽  
Stenotic Lesions

Background Severe intracranial arterial stenosis results in more than 10% incidence of stroke and transient ischemic attack. Using undersized angioplasty with off-label closed-cell Enterprise stent may be a feasible alternative option for treating patients with intracranial atherosclerotic disease who fail dual-antiplatelet medical therapy. The results of the authors’ study are presented in this paper. Materials and methods Between January 2013 and July 2014, 24 symptomatic patients with a total of 30 intracranial arterial stenotic lesions refractory to medical therapy, who underwent undersized angioplasty and Enterprise stenting, were retrospectively reviewed in the authors’ institution. The results evaluated include technical success rate, clinical outcome measured as modified Rankin Scale at presentation and follow-up, peri-procedural morbidity within 30 days and 1 year, and follow-up vessel patency. Results Stent deployment was successfully achieved in all stenotic lesions (30/30). Mean pre-stent and post-stent diameter residual stenosis was 81% and 18%, respectively. The peri-procedural complication rate during 30 days after stenting was 10% per lesion (3/30), including intracranial hemorrhage, in-stent thrombosis and ischemic stroke. No further thromboembolic event or complication occurred in any patient more than 30 days after stenting. Modified Rankin scale ≤ 2 was observed in 64% and 83% of patients at initial presentation and follow-up (mean 15.8 months), respectively. Imaging follow-up was available in 17 of 24 patients (70.8%) and 20 of 30 treated lesions (66.6%) with a mean follow-up period of 15.4 months. Only one asymptomatic in-stent restenosis occurred in 20 available lesions (5.0%). Conclusion This preliminary study suggests that using undersized angioplasty and Enterprise stenting may effectively treat high-degree symptomatic intracranial arterial stenosis with favorable clinical and angiographic outcome.

Abstract W P105: Comparison of Intracranial Stent Placement and Best Medical Treatment Alone for Treatment of Symptomatic Intracranial Stenosis

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Vikram Jadhav ◽  
Mushtaq Qureshi ◽  
Nidaullah Mian ◽  
Adnan I Qureshi
Keyword(s):  
Medical Treatment ◽  
Publication Bias ◽  
Medical Therapy ◽  
Stent Placement ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Post Treatment ◽  
Arterial Stenosis ◽  
Intracranial Stent ◽  
Best Medical Treatment

Objective: To compare the short and long term rates of transient ischemic attack (TIA)/ ischemic stroke and mortality between intracranial stent placement and medical therapy alone for treatment of symptomatic intracranial arterial stenosis. Methods: We identified all prospective and retrospective studies comparing intracranial stent placement and medical management using a search on PubMed and Cochrane libraries, stroke trials database, proceedings of neurology and neurosurgery related conferences, and supplemented by a review of bibliographies of selected publications. The incidences of adverse effects, namely TIA/stroke and/or death at 30 days post treatment and TIA/stroke, myocardial infarction and/or death at 1 year post treatment were ascertained from all studies. For the meta-analysis, Forest plots and calculation of odds ratios [OR] with 95% confidence intervals [CI] using both fixed and random models were performed. The presence of publication bias was interrogated by funnel plot of Standard Error by log odds ratio. Results: Three prospective studies including two randomized clinical trials and one retrospective study were identified and included in the meta-analysis. There were a total of 46/347 (13.2%) stroke-and/or-deaths reported in the stent treatment group compared with 16/351 (4.5%) TIA/stroke-and/or-deaths in the medical therapy alone group at 30 days (OR, 2.97; P<0.001; CI 1.64-5.39). The pooled incidence of 1-year TIA/stroke-and/or-deaths in patients with stenting was 51/347 (14.7%), compared with 45/351 (12.8%) in the patients managed with medical therapy alone (OR 1.093; P = 0.815; CI 0.51-2.30). There was no publication bias. Conclusions: Despite the higher risk of 1 month TIA/stroke-and/or-deaths, patients undergoing intracranial stent placement have similar rates of TIA/stroke-and/or-deaths at 1 year compared with medical treatment alone.

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