Search

Objective To report 4 cases of intracranial arterial stenosis stenting via radial artery approach and summarize the experience of treatment. Methods and Results The clinical data and treatment process of 4 patients with ischemic stroke treated by intracranial arterial stenosis stenting via radial artery approach in The Affiliated Hospital of Qingdao University were reviewed in 2022. The stenoses were located in the initial segment of left internal carotid artery (ICA), the initial segment of right vertebral artery (VA), the V4 segment of left VA, and the junction of V4 segment of left VA and the basilar artery, respectively. All the 4 patients underwent transradial approach stenting for ICA stenosis. The surgery was successful and the stenoses were recanalized. No adverse reactions were observed during and after the surgery. Conclusions Intracranial arterial stenosis stenting via radial artery approach is safe and effective in the treatment of ischemic stroke.

Objective A recent randomized controlled trial suggested that aggressive medical management was superior to angioplasty for symptomatic intracranial artery stenosis. But it still had its flaws. This study investigated the perioperative safety of balloon angioplasty for symptomatic intracranial artery stenosis. Methods Twenty-eight patients with severe symptomatic intracranial artery stenosis were treated by balloon dilatation alone from May 2016 to May 2019. The success rate, complications, modified Rankin scale (mRS) and follow-up data were evaluated. Results Twenty-six of 28 patients underwent balloon angioplasty successfully with a success rate of 92.86%. Immediate distal stenosis perfusion was more than Modified Thrombdysis in Cerebral Infarction (mTICI) grade 2b. Stent-assisted angioplasty was used in the other 2 cases. No complications related to worsening clinical symptoms occurred in 28 patients after operation and 30 d of follow-up. There were 10 patients whose modified Rankin Scale (mRS) score was 1 on the 30th day after operation, and the other 18 patients' mRS score was 0. Conclusions Balloon angioplasty is relatively safe in the perioperative period of symptomatic intracranial artery stenosis. Stent-assisted angioplasty is a technique used when balloon angioplasty is ineffective. [ABSTRACT FROM AUTHOR]

Recently, concerns about cognitive impairment and its association with carotid artery stenosis have been raised up progressively. Carotid artery stenting (CAS) is a well - established method which has been widely applied for ischemic stroke. However, its impact on cognitive function remains controversial. CAS can improve cognitive function by reducing the incidence of ischemic stroke and improving hemodynamic status, while postoperative microembolic events can lead to increased cognitive impairment. In addition, the effect of CAS on cognitive function is also affected by many other factors, including white matter hyperintensity (WMH), cerebral microbleeds (CMBs), depression, advanced age, etc. Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis - Hemodynamics (CREST-H) is expected to provide a clearer understanding of the therapeutic effects of CAS in cognitive function in conclusion. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of location of intracranial arterial stenosis on the safety of intracranial stenting. Methods A total of 73 patients with symptomatic intracranial atherosclerotic stenosis (ICAS) were divided into intracranial internal carotid artery (IICA, N = 18), middle cerebral artery (MCA)-M1 segment (MCA-M1, N = 11), intracranial vertebral artery (IVA, N = 27) and basilar artery (BA, N = 17). All of them underwent intracranial stenting. The improvement of intracranial arterial stenosis, cerebrovascular complications including perforating events, artery dissection, in - stent thrombosis, distal stent arterial embolism and cerebral hyperperfusion, and neurological complications including transient ischemic attack (TIA), ischemic stroke and intracranial hemorrhage were recorded. Modified Rankin Scale (mRS) was used to evaluate the prognosis 30 d after operation. Results A total of 73 stents were implanted in 73 patients (35 Apollo balloon - expandable stents and 38 Wingspan self - expandable stents). Among them, 10 cases (10/18) were treated with Apollo stents and 8 cases (8/18) with Wingspan stents in IICA group, 5 cases (5/11) were treated with Apollo stents and 6 cases (6/11) with Wingspan stents in MCA-M1 group, 16 cases (59.26%, 16/27) were treated with Apollo stents and 11 cases (40.74%, 11/27) with Wingspan stents in IVA group, and 4 cases (4/17) were treated with Apollo stents and 13 cases (13/17) with Wingspan stents in BA group. No significant difference was seen in stent type among 4 groups (χ² = 7.422, P = 0.201). The stenosis rate of IICA group after treatment [(10.94 ± 1.99)%] was significantly improved than before treatment [(90.89 ± 7.71)%; t = 69.545, P = 0.000]. The stenosis rate of MCA - M1 group after treatment [(10.37 ± 2.14)%] was significantly improved than before treatment [(87.64 ± 9.46)%; t = 26.000, P = 0.000]. The stenosis rate of IVA group after treatment [(11.02 ± 1.99)% ] was significantly improved than before treatment [(89.11 ± 7.97)%; t = 50.726, P = 0.000]. The stenosis rate of BA group after treatment [(10.99 ± 3.39)%] was significantly improved than before treatment [(91.35 ± 5.62)%; t = 69.545, P = 0.000]. In 73 patients, cerebrovascular complications occurred in 11 cases (15.07%), including 4 cases of perforating events, 4 cases of artery dissection, one case of in-stent thrombosis and 2 cases of distal stent arterial embolism. There were 3 cases (3/18) in IICA group, including 2 cases of artery dissection and one case of distal stent arterial embolism, and 8 cases (8/17) in BA group, including 4 cases of perforating events, 2 cases of artery dissection, one case of in - stent thrombosis and one case of distal stent arterial embolism. No cerebrovascular complications occurred in MCA-M1 group and IVA group. The difference among 4 groups was statistically significant (H = 63.134, P = 0.000). Neurological complications occurred in 6 cases (8.22%), including 4 cases of TIA and 2 cases of ischemic stroke. There was one case (1/18) of ischemic stroke in IICA group, and 5 cases (5/17) in BA group, including 4 cases of TIA and one case of ischemic stroke. No neurological complications occurred in MCA-M1 group and IVA group. The difference among 4 groups was statistically significant (H = 65.698, P = 0.003). At 30 d after operation, there was one case with mRS 1 score in IICA group and one in BA group. The total rate of good prognosis 30 d after operation was 97.26% (71/73). Conclusions The location of intracranial arterial stenosis have a great influence on the risk of perioperative cerebrovascular and neurological complications in the intracranial stenting, and the overall prognosis is good. [ABSTRACT FROM AUTHOR]