Long-Term Evolutionary Change in the Lumen of Intracranial Atherosclerotic Stenosis Following Angioplasty and Stenting. Issue 2 (14th June 2017)

• Record Type: Journal Article
• Authors: Yu, Simon C H; Lau, Tiffany W W; Wong, Simon S M; Lee, Kwok T; Wong, Lawrence K S; Leung, Thomas W H
• Is Part Of: Operative neurosurgery. Volume 14:Issue 2(2018)
• Page Start: 128
• Page End: 138
• Publication Date: 2017-06-14
• Subjects: Cone-beam CT -- Angiography -- Angioplasty and stenting -- Intracranial atherosclerotic stenosis -- Stroke -- Longitudinal study -- Luminal change; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opx097
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: BACKGROUND: Angioplasty and stenting is a recognized treatment option for patients with intracranial atherosclerosis. OBJECTIVE: To evaluate the long-term evolutionary luminal changes of intracranial atherosclerosis after angioplasty and stenting. METHODS: This was a retrospective study with patient consent. Eighty-two patients presenting with acute and minor cerebral ischemia due to stenosis ≥70%, who had received medical therapy with or without stenting (Wingspan), were invited. Luminal imaging was provided using 3-dimensional rotational angiography (3-DRA) at baseline and 12 mo, and cone-beam computed tomography angiography with intravenous contrast (CBCT) was provided at follow-up (median 82.4 mo [interquartile range 61.9-96.9 mo]). RESULTS: Thirty-six patients in the stenting group and 26 patients in the medical group were recruited and completed the study. There was no statistically significant difference in demographics between the 2 patient groups. The luminal gain at 12 or 80 mo as compared to baseline in the stenting group was significantly greater than that in the medical group (12 mo: median gain 30% vs 7.2%, P < .001; 80 mo: median gain 42.9% vs 7.2%, P < .0001). Luminal loss or unchanged lumen was correlated with recurrent ischemic event. The differences in the stenosis degree assessment between CBCT and 3-DRA in the same 10 patients with or without stenting were 1.2 ± 0.6% or 0.2 ± 0.06%, respectively. There was a correlation between recurrent ischemic events and luminal loss. CONCLUSION: Arterial lumen after angioplasty and stenting can probably be well maintained and delayed luminal gain does occur, long-term luminal loss is associated with recurrent ischemic events, CBCT might be useful as a less-invasive means for long-term assessment.