醫學研究

Long-term evolutionary change in the lumen of intracranial atherosclerotic stenosis following angioplasty and stenting

Yu SCH, Lau TWW, Wong SSM, Lee KT, Wong LKS, Leung TWH.  Oper Neurosurg (Hagerstown). 2018 Feb 1;14(2):128-138. doi: 10.1093/ons/opx097. PMID: 28637237.

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.

Citation:

https://pubmed.ncbi.nlm.nih.gov/28637237/