Journal article
Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management
World neurosurgery, Vol.123, pp.e693-e699
03/2019
DOI: 10.1016/j.wneu.2018.12.008
PMID: 30576811
Abstract
The optimal management of intracranial arterial stenosis is unclear, particularly in patients who have failed medical management. We report a multicenter real-world experience of endovascular recanalization of intracranial atherosclerotic stenosis refractory to aggressive medical therapy.
Retrospective multicenter case series of consecutive endovascularly treated patients presenting with symptomatic (transient ischemic attack [TIA] or stroke) intracranial stenosis who had failed medical therapy. Patients were divided into 2 groups: patients with recurrent TIA or stroke despite medical management (group 1) versus patients presenting with a stroke and worsening symptoms (progressive or crescendo stroke) despite medical management (group 2).
A total of 101 patients were treated in 8 stroke centers from August 2009 to May 2017. Sixty-nine presented with recurrent TIA or stroke and 32 with stroke and worsening symptoms. Successful recanalization was achieved in 84% of patients. Periprocedural stroke occurred in 3 patients and 2 had a recurrent ischemic stroke at the 90-day follow-up. Symptomatic intraparenchymal hemorrhage secondary to reperfusion injury occurred in 3 patients and 1 had a hemorrhagic stroke after discharge. There were 2 periprocedural perforations that resulted in death. At 90 days, 86% of patients (64/74) did not have a recurrence of stroke and the 90-day cumulative ischemic stroke rate was 6.7% with 90-day mortality of 11.2%. The 90-day favorable outcome (modified Rankin Scale score, ≤2) rate was 77.5%.
Endovascular recanalization of unstable intracranial atherosclerotic stenosis in patients who have failed medical therapy is feasible. Future randomized trials need to determine if recanalization is of any value for this population.
Details
- Title: Subtitle
- Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management
- Creators
- Amin Aghaebrahim - Lyerly Neurosurgery/Baptist Health, Baptist Neurological Institute, Jacksonville, Florida, USAGuilherme Jose Agnoletto - Lyerly Neurosurgery/Baptist Health, Baptist Neurological Institute, Jacksonville, Florida, USAPedro Aguilar-Salinas - Lyerly Neurosurgery/Baptist Health, Baptist Neurological Institute, Jacksonville, Florida, USAManuel F Granja - Lyerly Neurosurgery/Baptist Health, Baptist Neurological Institute, Jacksonville, Florida, USAAndre Monteiro - Lyerly Neurosurgery/Baptist Health, Baptist Neurological Institute, Jacksonville, Florida, USAAdnan H Siddiqui - Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, Buffalo, New York, USAElad I Levy - Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, Buffalo, New York, USAHussain Shallwani - Department of Neurosurgery and Toshiba Stroke Research Center, University at Buffalo, Buffalo, New York, USASong J Kim - Department of Neurology, Grady Memorial Hospital/Emory University School of Medicine, Atlanta, Georgia, USADiogo C Haussen - Department of Neurology, Grady Memorial Hospital/Emory University School of Medicine, Atlanta, Georgia, USARaul G Nogueira - Department of Neurology, Grady Memorial Hospital/Emory University School of Medicine, Atlanta, Georgia, USADemetrius Lopes - Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USAAhmed Saied - Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USATudor G Jovin - Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USAAshutosh P Jadhav - Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USAKaustubh Limaye - Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USAAquilla S Turk - Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USAAlejandro M Spiotta - Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USAMohammad I Chaudry - Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USARaymond D Turner - Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USALeonardo B.C Brasiliense - Division of Neurosurgery, University of Arizona, Tucson, Arizona, USATravis M Dumont - Division of Neurosurgery, University of Arizona, Tucson, Arizona, USAJacob Cherian - Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USAPeter Kan - Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USAEric Sauvageau - Lyerly Neurosurgery/Baptist Health, Baptist Neurological Institute, Jacksonville, Florida, USARicardo A Hanel - Lyerly Neurosurgery/Baptist Health, Baptist Neurological Institute, Jacksonville, Florida, USA
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.123, pp.e693-e699
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.wneu.2018.12.008
- PMID
- 30576811
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Grant note
- Cardinal StimMed Valor Medical International Medical Distribution Partners Buffalo Technology Partners Inc. Medina Medical Systems Neuro Technology Investors Endostream Medical Ltd.
- Language
- English
- Date published
- 03/2019
- Academic Unit
- Neurology; Radiology
- Record Identifier
- 9984020621302771
Metrics
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