Early and intermediate-term outcomes with drug-eluting stents in high-risk patientswith symptomatic intracranial stenosis

Adnan I. Qureshi, Jawad F. Kirmani, Haitham M. Hussein, Pansy Harris-Lane, Afshin A. Divani, M. Fareed K. Suri, Nazli Janjua, Ammar Alkawi

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73 Scopus citations

Abstract

OBJECTIVE: To report the 1-month and intermediate-term results of treatment of symptomatic intracranial stenosis using drug-eluting stents. BACKGROUND: Patients with intracranial stenosis who are at high risk because of either high-grade stenosis or medication failure may have an annual risk of recurrent ischemic events in excess of 40%. Drug-eluting stents may reduce the rate of ischemic events in patients with a low restenosis rate. METHODS: We determined rates of technical success (defined as reduction of target lesion to stenosis <30%) and 1-month major stroke or death in patients with symptomatic intracranial stenosis (≥70% and/or medication failure). Patients' clinical and follow-up information during a mean period of 14.3 ± 7 months were obtained. Kaplan-Meier analysis was performed to determine the rate of major stroke-free survival during 12 months. RESULTS: There were 18 patients (mean age, 58 ± 16 yr; 12 were men) treated with either a sirolimus-eluting stent (n = 14) or a paclitaxel-eluting stent (n = 4) for stenosis located in the: intracranial internal carotid artery (n = 6), proximal middle cerebral artery (n = 4), intracranial vertebral artery (n = 4), vertebrobasilar junction (n = 2), or basilar artery (n = 2). There was one major stroke and no death observed in the 1-month follow-up. At the 6-month follow-up examination, no major stroke or death was observed. Major stroke-free survival was 86% (±standard error of 9%) at 12 months after the procedure. One symptomatic angiographic restenosis was observed during the follow-up period. CONCLUSION: A low rate of major stroke or death was observed after treatment of symptomatic intracranial stenosis using drug-eluting stents in high-risk patients.

Original languageEnglish (US)
Pages (from-to)1044-1051
Number of pages8
JournalNeurosurgery
Volume59
Issue number5
DOIs
StatePublished - Nov 1 2006

Keywords

  • Angioplasty
  • Intracranial atherosclerosis
  • Ischemic stroke
  • Stent
  • Transient ischemic attack

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