Treatment of intracranial atherosclerotic disease with a balloon-expandable paclitaxel eluting stent procedural safety, efficacy and mid-term patency

Z. Vajda, M. Aguilar, T. Göhringer, D. Horváth-Rizea, H. Bäzner, H. Henkes

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Purpose: Procedural safety and high rates of in-stent recurrent stenotic lesions (ISR) remain a concern in the endovascular treatment of intracranial atherosclerotic disease (ICAD). In the present study technical feasibility, safety and efficacy of the paclitaxel eluting balloon-expandable coronary stent Coroflex® Please was assessed in the treatment of ICAD. Methods: A total of 95 patients (79 male; median age 68 years) with 106 intracranial atherosclerotic stenotic lesions underwent endovascular treatment using Coroflex® Please stents (B. Braun, Melsungen, Germany). Location and degree of target stenoses before and after treatment and at follow-up and adverse clinical sequelae of treatment were registered. Post-procedural medication included 100 mg acetylsalicylic acid (ASA) and 75 mg clopidogrel for 1 year. Angiographic follow-up was scheduled for 6, 12, 26 and 52 weeks after the treatment. Results: T he lesion locations were as follows: internal carotid artery (ICA) petrous (n = 44, 42%), ICA cavernous (n = 43, 41%), ICA paraclinoid (n = 4, 4%), intradural vertebral artery (VA; n = 11, 10%) and basilar artery (BA; n = 4, 4%). Of the lesions seven could not be treated due to difficult anatomy and stent stiffness (7% technical failure rate). The combined post-interventional neurological morbidity and mortality rate, including stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and carotid cavernous fistula (CCF) was n = 4 (3.7%) within and n = 1 (0.9%) at and beyond 30 days, respectively. Angiographic and clinical follow-up examinations were carried out for 78 (78%) of the lesions (mean 16.1 months, maximum 48 months). Asymptomatic recurrent stenosis was seen in 3 out of 78 (3.8%) lesions and there was 1 case of late stent thrombosis (0.9%). Conclusions: T reatment of ICAD using drug-eluting coronary stents is safe and effective but technical failure due to stent stiffness remains a problem. Application of the more flexible, newest generation thin-strut stents, however, shows promising results.

Original languageEnglish
Pages (from-to)227-233
Number of pages7
JournalClinical Neuroradiology
Volume22
Issue number3
DOIs
Publication statusPublished - Sep 2012

Fingerprint

Paclitaxel
Stents
Safety
Internal Carotid Artery
clopidogrel
Therapeutics
Pathologic Constriction
Basilar Artery
Drug-Eluting Stents
Vertebral Artery
Cerebral Hemorrhage
Feasibility Studies
Subarachnoid Hemorrhage
Aspirin
Fistula
Germany
Anatomy
Thrombosis
Stroke
Morbidity

Keywords

  • Atherosclerosis
  • Drug-eluting stent
  • Endovascular
  • Intracranial stenosis
  • Stroke
  • Transitory ischemic attack

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

Cite this

Treatment of intracranial atherosclerotic disease with a balloon-expandable paclitaxel eluting stent procedural safety, efficacy and mid-term patency. / Vajda, Z.; Aguilar, M.; Göhringer, T.; Horváth-Rizea, D.; Bäzner, H.; Henkes, H.

In: Clinical Neuroradiology, Vol. 22, No. 3, 09.2012, p. 227-233.

Research output: Contribution to journalArticle

Vajda, Z. ; Aguilar, M. ; Göhringer, T. ; Horváth-Rizea, D. ; Bäzner, H. ; Henkes, H. / Treatment of intracranial atherosclerotic disease with a balloon-expandable paclitaxel eluting stent procedural safety, efficacy and mid-term patency. In: Clinical Neuroradiology. 2012 ; Vol. 22, No. 3. pp. 227-233.
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AU - Horváth-Rizea, D.

AU - Bäzner, H.

AU - Henkes, H.

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N2 - Purpose: Procedural safety and high rates of in-stent recurrent stenotic lesions (ISR) remain a concern in the endovascular treatment of intracranial atherosclerotic disease (ICAD). In the present study technical feasibility, safety and efficacy of the paclitaxel eluting balloon-expandable coronary stent Coroflex® Please was assessed in the treatment of ICAD. Methods: A total of 95 patients (79 male; median age 68 years) with 106 intracranial atherosclerotic stenotic lesions underwent endovascular treatment using Coroflex® Please stents (B. Braun, Melsungen, Germany). Location and degree of target stenoses before and after treatment and at follow-up and adverse clinical sequelae of treatment were registered. Post-procedural medication included 100 mg acetylsalicylic acid (ASA) and 75 mg clopidogrel for 1 year. Angiographic follow-up was scheduled for 6, 12, 26 and 52 weeks after the treatment. Results: T he lesion locations were as follows: internal carotid artery (ICA) petrous (n = 44, 42%), ICA cavernous (n = 43, 41%), ICA paraclinoid (n = 4, 4%), intradural vertebral artery (VA; n = 11, 10%) and basilar artery (BA; n = 4, 4%). Of the lesions seven could not be treated due to difficult anatomy and stent stiffness (7% technical failure rate). The combined post-interventional neurological morbidity and mortality rate, including stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and carotid cavernous fistula (CCF) was n = 4 (3.7%) within and n = 1 (0.9%) at and beyond 30 days, respectively. Angiographic and clinical follow-up examinations were carried out for 78 (78%) of the lesions (mean 16.1 months, maximum 48 months). Asymptomatic recurrent stenosis was seen in 3 out of 78 (3.8%) lesions and there was 1 case of late stent thrombosis (0.9%). Conclusions: T reatment of ICAD using drug-eluting coronary stents is safe and effective but technical failure due to stent stiffness remains a problem. Application of the more flexible, newest generation thin-strut stents, however, shows promising results.

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