Percutaneous Transluminal Angioplasty and Stenting for Symptomatic Intracranial Stenosis After SAMMPRIS: Patient Selection and Clinical Outcomes

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Abstract

Background/ Objectives; After negative results of the SAMMPRIS-trial the indication for endovascular treatment of atherosclerotic intracranial artery stenosis (ICAS) was widely restricted. It was the aim of our study to report whether intracranial arterial percutaneous transluminal angioplasty and stenting (PTAS) as ultima ratio therapy is still effective and safe enough. Methods: Between February 2011 and June 2019, 63 consecutive patients with and without emergent large vessel occlusion (ELVO) who received PTAS for symptomatic ICAS in the anterior or vertebrobasilar circulation were in-cluded in our study. Results: 32 patients had ELVO. In the remaining 31 patients, a known ICAS was treated with PTAS either because of recurrent stroke despite aggressive medical therapy with dual antiplatelet inhibition (n=24) or due to progressive hemodynamic ischemia (n=7). Stenting was successful in all 63 cases. Successful reperfusion was achieved in 94% of ELVO patients. Complications with new neurologic deficits, including dissection, subarachnoid hemorrhage, in-tracerebral hemorrhage (PH2), and stent-thrombosis, were seen in 5 ELVO patients (16%). At discharge, neuro-logical status improved in 16 patients (50%) and deteriorated in 7 patients (22%). In-hospital mortality happened in 5 of 32 ELVO cases (16%), all of them had lesions in the vertebrobasilar circulation. Regarding non-ELVO cases, two patients (6%) developed new neurologic deficits due to perforator strokes. There was no in-hospital mortality in this group. Conclusion: Even in unfavorable situations with acute atherothrombotic occlusions or recurrent strokes under ag-gressive medical therapy of known ICAS, PTAS remains a treatment option with reasonable efficacy and tolerable complication rates.

Authors 7

1. Leonhard Mann

   University Hospital Frankfurt · Goethe University Frankfurt

   Affiliation as printed

   Goethe-University , University Hospital Frankfurt , Institute of Neuroradiology , Frankfurt , Germany

2. Patrick Felix Samp

   University Hospital Frankfurt · Goethe University Frankfurt

   Affiliation as printed

   Goethe-University , University Hospital Frankfurt , Institute of Neuroradiology , Frankfurt , Germany

3. Jan Hendrik Schäefer
4. Elke Hattingen

   University Hospital Frankfurt · Goethe University Frankfurt

   Affiliation as printed

   Goethe-University , University Hospital Frankfurt , Institute of Neuroradiology , Frankfurt , Germany

5. Joachim Berkefeld

   University Hospital Frankfurt · Goethe University Frankfurt

   Affiliation as printed

   Goethe-University , University Hospital Frankfurt , Institute of Neuroradiology , Frankfurt , Germany

6. Dimah Hasan Aachen Department of Diagnostic and Interventional Neuroradiology

   RWTH Aachen University · Universitätsklinikum Aachen · University Hospital Frankfurt · Goethe University Frankfurt

   Affiliation as printed

   Goethe-University , University Hospital Frankfurt , Institute of Neuroradiology , Frankfurt , Germany

   RWTH University , Hospital Aachen , Department of Diagnostic and Interventional Neuroradiology , Aachen , Germany

7. Fee Christiane Keil corresponding

   University Hospital Frankfurt · Goethe University Frankfurt

   Affiliation as printed

   Goethe-University , University Hospital Frankfurt , Institute of Neuroradiology , Frankfurt , Germany