Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management.

Related Articles

Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management.

World Neurosurg. 2018 Dec 18;:

Authors: Aghaebrahim A, Agnoletto GJ, Aguilar-Salinas P, Granja MF, Monteiro A, Siddiqui AH, Levy EI, Shallwani H, Kim SJ, Haussen DC, Nogueira RG, Lopes D, Saied A, Jovin TG, Jadhav AP, Limaye K, Turk AS, Spiotta AM, Chaudry MI, Turner RD, Brasiliense LBC, Dumont TM, Cherian J, Kan P, Sauvageau E, Hanel RA

Abstract
BACKGROUND: and Purpose. 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.
METHODS: Retrospective multicenter case series of consecutive endovascularly treated patients presenting with symptomatic (TIA or stroke) intracranial stenosis who had failed medical therapy. Patients were divided into two groups: patients with recurrent TIA or stroke despite medical management (group 1) vs. patients presenting with a stroke and worsening symptoms (progressive or crescendo stroke) despite medical management (group 2).
RESULTS: 101 patients were treated in 8 stroke centers from August 2009 to May 2017. 69 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 which resulted in death. At 90 days, 86% (64/74) of patients did not have a recurrence of stroke and the 90-day cumulative ischemic stroke rate was 6.7% with 90 day mortality rate of 11.2%. The 90-day favorable outcome (mRS ≤ 2) rate was 77.5%.
CONCLUSIONS: 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.

PMID: 30576811 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2GBQUIn