Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management

Amin Aghaebrahim, Guilherme Jose Agnoletto, Pedro Aguilar-Salinas, Manuel F. Granja, Andre Monteiro, Adnan H. Siddiqui, Elad I. Levy, Hussain Shallwani, Song J. Kim, Diogo C. Haussen, Raul G. Nogueira, Demetrius Lopes, Ahmed Saied, Tudor G. Jovin, Ashutosh P. Jadhav, Kaustubh Limaye, Aquilla S. Turk, Alejandro M. Spiotta, Mohammad I. Chaudry, Raymond D. TurnerLeonardo B.C. Brasiliense, Travis M Dumont, Jacob Cherian, Peter Kan, Eric Sauvageau, Ricardo A. Hanel

Research output: Contribution to journalArticle

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Abstract

Background: 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 (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). Results: 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%. 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.

Original languageEnglish (US)
Pages (from-to)e693-e699
JournalWorld neurosurgery
Volume123
DOIs
StatePublished - Mar 1 2019

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Pathologic Constriction
Stroke
Transient Ischemic Attack
Reperfusion Injury
Therapeutics
Hemorrhage
Recurrence
Mortality

Keywords

  • Angioplasty
  • Intracranial atherosclerosis
  • Stents
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Aghaebrahim, A., Agnoletto, G. J., Aguilar-Salinas, P., Granja, M. F., Monteiro, A., Siddiqui, A. H., ... Hanel, R. A. (2019). Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management. World neurosurgery, 123, e693-e699. https://doi.org/10.1016/j.wneu.2018.12.008

Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management. / Aghaebrahim, Amin; Agnoletto, Guilherme Jose; Aguilar-Salinas, Pedro; Granja, Manuel F.; Monteiro, Andre; Siddiqui, Adnan H.; Levy, Elad I.; Shallwani, Hussain; Kim, Song J.; Haussen, Diogo C.; Nogueira, Raul G.; Lopes, Demetrius; Saied, Ahmed; Jovin, Tudor G.; Jadhav, Ashutosh P.; Limaye, Kaustubh; Turk, Aquilla S.; Spiotta, Alejandro M.; Chaudry, Mohammad I.; Turner, Raymond D.; Brasiliense, Leonardo B.C.; Dumont, Travis M; Cherian, Jacob; Kan, Peter; Sauvageau, Eric; Hanel, Ricardo A.

In: World neurosurgery, Vol. 123, 01.03.2019, p. e693-e699.

Research output: Contribution to journalArticle

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 2019, 'Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management', World neurosurgery, vol. 123, pp. e693-e699. https://doi.org/10.1016/j.wneu.2018.12.008
Aghaebrahim A, Agnoletto GJ, Aguilar-Salinas P, Granja MF, Monteiro A, Siddiqui AH et al. Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management. World neurosurgery. 2019 Mar 1;123:e693-e699. https://doi.org/10.1016/j.wneu.2018.12.008
Aghaebrahim, Amin ; Agnoletto, Guilherme Jose ; Aguilar-Salinas, Pedro ; Granja, Manuel F. ; Monteiro, Andre ; Siddiqui, Adnan H. ; Levy, Elad I. ; Shallwani, Hussain ; Kim, Song J. ; Haussen, Diogo C. ; Nogueira, Raul G. ; Lopes, Demetrius ; Saied, Ahmed ; Jovin, Tudor G. ; Jadhav, Ashutosh P. ; Limaye, Kaustubh ; Turk, Aquilla S. ; Spiotta, Alejandro M. ; Chaudry, Mohammad I. ; Turner, Raymond D. ; Brasiliense, Leonardo B.C. ; Dumont, Travis M ; Cherian, Jacob ; Kan, Peter ; Sauvageau, Eric ; Hanel, Ricardo A. / Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management. In: World neurosurgery. 2019 ; Vol. 123. pp. e693-e699.
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abstract = "Background: 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 (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). Results: 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{\%}. 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.",
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T1 - Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management

AU - Aghaebrahim, Amin

AU - Agnoletto, Guilherme Jose

AU - Aguilar-Salinas, Pedro

AU - Granja, Manuel F.

AU - Monteiro, Andre

AU - Siddiqui, Adnan H.

AU - Levy, Elad I.

AU - Shallwani, Hussain

AU - Kim, Song J.

AU - Haussen, Diogo C.

AU - Nogueira, Raul G.

AU - Lopes, Demetrius

AU - Saied, Ahmed

AU - Jovin, Tudor G.

AU - Jadhav, Ashutosh P.

AU - Limaye, Kaustubh

AU - Turk, Aquilla S.

AU - Spiotta, Alejandro M.

AU - Chaudry, Mohammad I.

AU - Turner, Raymond D.

AU - Brasiliense, Leonardo B.C.

AU - Dumont, Travis M

AU - Cherian, Jacob

AU - Kan, Peter

AU - Sauvageau, Eric

AU - Hanel, Ricardo A.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: 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 (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). Results: 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%. 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.

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KW - Angioplasty

KW - Intracranial atherosclerosis

KW - Stents

KW - Stroke

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