Application of Neuroform EZ stent in the treatment of severe intracranial arterial stenosis with complex symptomatic

  • Zi-chang JIA ,
  • Huan-ju BIAN ,
  • Xuan LI ,
  • Jing-yuan LUAN ,
  • Chang-ming WANG ,
  • Qi-jia LIU ,
  • Jin-tao HAN
Expand
  • 1. Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, ChinaDepartment of Neurology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Neurology, Guanxian People’s Hospital, Liaocheng 252500, Shandong, China

Received date: 2018-08-29

  Online published: 2019-10-23

Abstract

Objective: To assess the safety and efficacy of Neuroform EZ stent used in treatment of symptomatic complex severe intracranial atherosclerotic stenosis (ICAS). Methods: Clinical data of 18 patients with symptomatic complex severe ICAS undergoing Neuroform EZ stent angioplasty from January 2016 to December 2017 were retrospectively analyzed. All the lesions of the patients in this group were considered as complex ICAS, i.e. with severe tortuous access, long (>10 mm) or occlusive or bifurcation lesions, with concurrent aneurysms near the stenotic lesion. The primary outcome was defined as any stroke (including ischemic or hemorrhagic) or deaths from any cause after stenting procedure within 30 days. The secondary outcome was defined as successful revascularization and occurrence of >50% in-stent restenosis during the follow-up period. Results: All the 18 patients achieved technical success (100%) and mean stenosis rate was reduced from 85%±7% to 18%±6%. Of the 18 patients inclu-ded, the 30-day stroke or death was 5.6% (1/18), which presented as basal ganglia region infarction in a patient with tandem lesions on the left vertebral artery. There was no hemorrhagic and death complications that occurred in the patients of this group. One concurrent aneurysm was embolized with micro coil (stent assisted) by stages after 1 month. In this group 12 patients were followed up with digital subtraction angiography (DSA) after hospital discharge. The follow-up period ranged from 8 months to 26 months [mean: (16±8) months].During the follow-up period 2 patients in the 12 patients (2/12, 16.7%) developed in-stent restenosis (ISR) confirmed by DSA, and one of them was symptomatic res-tenosis and restored unobstructed blood flow after balloon angioplasty. Conclusion: Neuroform EZ stent for the treatment of highly screened symptomatic complex severe ICAS is safe and effective. It has its advantages over traditional stent.

Cite this article

Zi-chang JIA , Huan-ju BIAN , Xuan LI , Jing-yuan LUAN , Chang-ming WANG , Qi-jia LIU , Jin-tao HAN . Application of Neuroform EZ stent in the treatment of severe intracranial arterial stenosis with complex symptomatic[J]. Journal of Peking University(Health Sciences), 2019 , 51(5) : 835 -839 . DOI: 10.19723/j.issn.1671-167X.2019.05.008

References

[1] Wang Y, Zhao X, Liu L , et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study[J]. Stroke, 2014,45(3):663-669.
[2] Wong LK . Global burden of intracranial atherosclerosis[J]. Int J Stroke, 2006,1(3):158-159.
[3] Chimowitz MI, Lynn MJ, Howlett-Smith H , et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis[J]. N Engl J Med, 2005,352(13):1305-1316.
[4] Chimowitz MI, Lynn MJ, Derdeyn CP , et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis[J]. N Engl J Med, 2011,365(11):993-1003.
[5] Zaidat OO, Fitzsimmons BF, Woodward BK , et al. Effect of a balloon-expandable intracranial stent vs. medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial[J]. JAMA, 2015,313(12):1240-1248.
[6] Miao Z, Zhang Y, Shuai J . Study Group of registry study of sten-ting for symptomatic intracranial artery stenosis in China: Thirty-day outcome of a multicenter registry study of stenting for sympto-matic intracranial artery stenosis in China[J]. Stroke, 2015,46(10):2822-2829.
[7] Wang Y, Miao Z, Wang Y , et al. Protocol for a prospective, multicenter registry study of stenting for symptomatic intracranial artery stenosis in China[J]. BMJ Open, 2014,4(8):e005175.
[8] Sacco RL, Kargman DE, Gu Q , et al. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study[J]. Stroke, 1995,26(1):14-20.
[9] Cheng XQ, Tian JM, Zuo CJ , et al. Hemodynamic alterations in unilateral chronic middle cerebral artery stenosis patients and the effect of percutaneous transluminal angioplasty and stenting: A perfusion-computed tomography study[J]. Acta Radiol, 2015,56(6):754-760.
[10] Duan G, Feng Z, Zhang L , et al. Solitaire stents for the treatment of complex symptomatic intracranial stenosis after antithrombotic failure: Safety and efficacy evaluation[J]. Neurointerv Surg, 2016,8(7):680-684.
[11] Marks MP . Is there a future for endovascular treatment of intracranial atherosclerotic disease after stenting and aggressive medical management for preventing recurrent stroke and intracranial stenosis (SAMMPRIS)?[J]. Stroke, 2012,43(2):580-584.
[12] Vajda Z, Guthe T, Perez MA , et al. Prevention of intracranial in-stent restenosis: Predilatation with a drug eluting balloon, followed by the deployment of a self-expanding stent[J]. Cardiovasc Intervent Radiol, 2013,36(2):346-352.
[13] Hahnel S, Ringleb P, Hartmann M . Treatment of intracranial stenosis using the Neuroform stent system: Initial experience in five cases[J]. Neuroradiology, 2016,48(7):479-485.
[14] Liu L, Ma N, Mo DP , et al. Enterprise stent in treatment of symptomatic complex intracranial atherosclerotic stenosis[J]. Chin J Stroke, 2017,12(7):592-597.
[15] Liu L, Zhao X, Mo D , et al. Stenting for symptomatic intracranial vertebrobasilar artery stenosis: 30-day results in a high-volume stroke center[J]. Clin Neurol Neurosurg, 2016,4(143):132-138.
[16] Krischek ?, Miloslavski E, Fischer S , et al. A comparison of functional and physical properties of self-expanding intracranial stents[J]. Minim Invasive Neurosurg, 2011,54(1):21-28.
[17] Shin YS, Kim BM, Suh SH , et al. Wingspan stenting for intracranial atherosclerotic stenosis: Clinical outcomes and risk factors for in-stent restenosis[J]. Neurosurgery, 2013,72(4):596-604.
[18] Vajda Z, Schmid E, Guthe T , et al. The modified Bose method for the endovascular treatment of intracranial atherosclerotic arterial stenoses using the Enterprise stent[J]. Neurosurgery, 2012,70(1):91-101.
Outlines

/