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Outcomes of mechanical thrombectomy in stroke patients with extreme large infarction core

Almallouhi, Eyad; Zandpazandi, Sara; Anadani, Mohammad; Cunningham, Conor; Sowlat, Mohammad-Mahdi; Matsukawa, Hidetoshi; Orscelik, Atakan; Elawady, Sameh Samir; Maier, Ilko; Al Kasab, Sami; Jabbour, Pascal; Kim, Joon-Tae; Wolfe, Stacey Q; Rai, Ansaar; Starke, Robert M; Psychogios, Marios-Nikos; Samaniego, Edgar A; Arthur, Adam S; Yoshimura, Shinichi; Cuellar, Hugo; Grossberg, Jonathan A; Alawieh, Ali; Romano, Daniele G; Tanweer, Omar; Mascitelli, Justin; Fragata, Isabel; Polifka, Adam J; Osbun, Joshua W; Crosa, Roberto Javier; Matouk, Charles; Park, Min S; Levitt, Michael R; Brinjikji, Waleed; Moss, Mark; Dumont, Travis M; Williamson, Richard; Navia, Pedro; Kan, Peter; De Leacy, Reade; Chowdhry, Shakeel A; Ezzeldin, Mohamad; Spiotta, Alejandro M
BACKGROUND:Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). In this study, we evaluate outcomes of MT in LVO patients presenting with extremely large infarction core Alberta Stroke Program Early CT Score (ASPECTS 0-2). METHODS:Data from the Stroke Thrombectomy and Aneurysm Registry (STAR) was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery and extremely large infarction core (ASPECTS 0-2). A favorable outcome was defined by achieving a modified Rankin scale of 0-3 at 90 days post-MT. Successful recanalization was defined by achieving a modified Thrombolysis In Cerebral Ischemia (mTICI) score ≥2B. RESULTS:We identified 58 patients who presented with ASPECTS 0-2 and underwent MT . Median age was 70.0 (59.0-78.0) years, 45.1% were females, and 202 (36.3%) patients received intravenous tissue plasminogen activator. There was no difference regarding the location of the occlusion (p=0.57). Aspiration thrombectomy was performed in 268 (54.6%) patients and stent retriever was used in 70 (14.3%) patients. In patients presenting with ASPECTS 0-2 the mortality rate was 4.5%, 27.9% had mRS 0-3 at day 90, 66.67% ≥70 years of age had mRS of 5-6 at day 90. On multivariable analysis, age, National Institutes of Health Stroke Scale on admission, and successful recanalization (mTICI ≥2B) were independently associated with favorable outcomes. CONCLUSIONS:This multicentered, retrospective cohort study suggests that MT may be beneficial in a select group of patients with ASPECTS 0-2.
PMID: 38041671
ISSN: 1759-8486
CID: 5616842

Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions: insights from STAR

Dabhi, Nisha; Kumar, Jeyan Sathia; Ironside, Natasha; Kellogg, Ryan T; Sowlat, Mohammad-Mahdi; Uchida, Kazutaka; Maier, Ilko; Al Kasab, Sami; Jabbour, Pascal; Kim, Joon-Tae; Wolfe, Stacey Q; Rai, Ansaar; Starke, Robert M; Psychogios, Marios-Nikos; Samaniego, Edgar A; Arthur, Adam S; Yoshimura, Shinichi; Cuellar, Hugo; Howard, Brian M; Alawieh, Ali; Romano, Daniele G; Tanweer, Omar; Mascitelli, Justin; Fragata, Isabel; Polifka, Adam J; Osbun, Joshua W; Crosa, Roberto Javier; Matouk, Charles; Levitt, Michael R; Brinjikji, Waleed; Moss, Mark; Dumont, Travis M; Williamson, Richard; Navia, Pedro; Kan, Peter; De Leacy, Reade; Chowdhry, Shakeel A; Ezzeldin, Mohamad; Spiotta, Alejandro M; Park, Min S
BACKGROUND:The safety and efficacy of mechanical thrombectomy (MT) for the treatment of acute anterior cerebral artery (ACA) occlusions have not clearly been delineated. Outcomes may be impacted based on whether the occlusion is isolated to the ACA (primary ACA occlusion) or occurs in conjunction with other cerebral arteries (secondary). METHODS:test for categorical variables. RESULTS:The study cohort comprised 238 patients with ACA occlusions (49.2% female, median (SD) age 65.6 (16.7) years). The overall rate of successful recanalization was 75%, 90-day good functional outcome was 23%, and 90-day mortality was 35%. There were 44 patients with a primary ACA occlusion and 194 patients with a secondary ACA occlusion. When adjusted for baseline variables, the rates of successful recanalization (68% vs 76%, P=0.27), 90-day good functional outcome (41% vs 19%, P=0.38), and mortality at 90 days (25% vs 38%, P=0.12) did not differ between primary and secondary ACA occlusion groups. CONCLUSION/CONCLUSIONS:Clinical and procedural outcomes are similar between MT-treated primary and secondary ACA occlusions for select patients. Our findings demonstrate the need for established criteria to determine ideal patient and ACA stroke characteristics amenable to MT treatment.
PMID: 37968114
ISSN: 1759-8486
CID: 5610682

Standalone middle meningeal artery embolization versus middle meningeal artery embolization with concurrent surgical evacuation for chronic subdural hematomas: a multicenter propensity score matched analysis of clinical and radiographic outcomes

Chen, Huanwen; Salem, Mohamed M; Colasurdo, Marco; Sioutas, Georgios S; Khalife, Jane; Kuybu, Okkes; Carroll, Kate T; Hoang, Alex Nguyen; Baig, Ammad A; Salih, Mira; Khorasanizadeh, Mirhojjat; Baker, Cordell; Mendez Ruiz, Aldo; Cortez, Gustavo M; Abecassis, Zack; Ruiz Rodríguez, Juan Francisco; Davies, Jason M; Narayanan, Sandra; Cawley, C Michael; Riina, Howard; Moore, Justin; Spiotta, Alejandro M; Khalessi, Alexander; Howard, Brian M; Hanel, Ricardo A; Tanweer, Omar; Tonetti, Daniel; Siddiqui, Adnan H; Lang, Michael; Levy, Elad I; Jovin, Tudor G; Grandhi, Ramesh; Srinivasan, Visish M; Levitt, Michael R; Ogilvy, Christopher S; Jankowitz, Brian; Thomas, Ajith J; Gross, Bradley A; Burkhardt, Jan Karl; Kan, Peter
BACKGROUND:Middle meningeal artery embolization (MMAE) has emerged as a promising therapy for chronic subdural hematomas (cSDHs). The efficacy of standalone MMAE compared with MMAE with concurrent surgery is largely unknown. METHODS:cSDH patients who underwent successful MMAE from 14 high volume centers with at least 30 days of follow-up were included. Clinical and radiographic variables were recorded and used to perform propensity score matching (PSM) of patients treated with standalone MMAE or MMAE with concurrent surgery. Multivariable logistic regression models were used for additional covariate adjustments. The primary outcome was recurrence requiring surgical rescue, and the secondary outcome was radiographic failure defined as <50% reduction of cSDH thickness. RESULTS:722 MMAE procedures in 588 cSDH patients were identified. After PSM, 230 MMAE procedures remained (115 in each group). Median age was 73 years, 22.6% of patients were receiving anticoagulation medication, and 47.9% had no preoperative functional disability. Median midline shift was 4 mm and cSDH thickness was 16 mm, representing modestly sized cSDHs. Standalone MMAE and MMAE with surgery resulted in similar rates of surgical rescue (7.8% vs 13.0%, respectively, P=0.28; adjusted OR (aOR 0.73 (95% CI 0.20 to 2.40), P=0.60) and radiographic failure (15.5% vs 13.7%, respectively, P=0.84; aOR 1.08 (95% CI 0.37 to 2.19), P=0.88) with a median follow-up duration of 105 days. These results were similar across subgroup analyses and follow-up durations. CONCLUSIONS:Standalone MMAE led to similar and durable clinical and radiographic outcomes as MMAE combined with surgery in select patients with moderately sized cSDHs and mild clinical disease.
PMID: 37932033
ISSN: 1759-8486
CID: 5620292

COManeci MechANical dilation for vasospasm (COMMAND): multicenter experience

Salem, Mohamed M; Khalife, Jane; Desai, Sohum; Sharashidze, Vera; Badger, Clint; Kuhn, Anna L; Monteiro, Andre; Salahuddin, Hisham; Siddiqui, Adnan H; Singh, Jasmeet; Levy, Elad I; Lang, Michael; Grandhi, Ramesh; Thomas, Ajith J; Lin, Li-Mei; Tanweer, Omar; Burkhardt, Jan-Karl; Puri, Ajit S; Gross, Bradley A; Nossek, Erez; Hassan, Ameer E; Shaikh, Hamza A; Jankowitz, Brian T
BACKGROUND:We report the largest multicenter experience to date of utilizing the Comaneci device for endovascular treatment of refractory intracranial vasospasm. METHODS:Consecutive patients undergoing Comaneci mechanical dilatation for vasospasm were extracted from prospectively maintained registries in 11 North American centers (2020-2022). Intra-arterial vasodilators (IAV) were allowed, with the Comaneci device utilized after absence of vessel dilation post-infusion. Pre- and post-vasospasm treatment scores were recorded for each segment, with primary radiological outcome of score improvement post-treatment. Primary clinical outcome was safety/device-related complications, with secondary endpoints of functional outcomes at last follow-up. RESULTS:A total of 129 vessels in 40 patients (median age 52 years; 67.5% females) received mechanical dilation, 109 of which (84.5%) exhibited pre-treatment severe-to-critical vasospasm (ie, score 3/4). Aneurysmal subarachnoid hemorrhage was the most common etiology of vasospasm (85%), with 65% of procedures utilizing Comaneci-17 (92.5% of patients received IAV). The most treated segments were anterior cerebral artery (34.9%) and middle cerebral artery (31%). Significant vasospasm drop (pre-treatment score (3-4) to post-treatment (0-2)) was achieved in 89.9% of vessels (96.1% of vessels experienced ≥1-point drop in score post-treatment). There were no major procedural/post-procedural device-related complications. Primary failure (ie, vessel unresponsive) was encountered in one vessel (1 patient) (1/129; 0.8%) while secondary failure (ie, recurrence in previously treated segment requiring retreatment in another procedure) occurred in 16 vessels (7 patients) (16/129; 12.4%), with median time-to-retreatment of 2 days. Favorable clinical outcome (modified Rankin Scale 0-2) was noted in 51.5% of patients (median follow-up 6 months). CONCLUSIONS:The Comaneci device provides a complementary strategy for treatment of refractory vasospasm with reasonable efficacy/favorable safety. Future prospective trials are warranted.
PMID: 36002289
ISSN: 1759-8486
CID: 5338272

Sonolucent Cranioplasty in Extracranial to Intracranial Bypass Surgery: Early Multicenter Experience of 44 Cases

Salem, Mohamed M; Ravindran, Krishnan; Hoang, Alex Nguyen; Doron, Omer; Esparza, Rogelio; Raper, Daniel; Jankowitz, Brian T; Tanweer, Omar; Lopes, Demetrius; Langer, David; Nossek, Erez; Burkhardt, Jan-Karl
BACKGROUND:The new sonolucent cranioplasty implant (clear polymethyl methacrylate, PMMA) adds functionality besides surgical reconstruction. One possible application uses the transcranioplasty ultrasound (TCUS) technique after PMMA cranioplasty to assess graft patency of extracranial-intracranial (EC-IC) bypass procedures. OBJECTIVE:To report our early multicenter experience. METHODS:This is a multicenter analysis of consecutive EC-IC bypass patients from 5 US centers (2019-2022) with closure postbypass using PMMA implant. RESULTS:Forty-four patients (median age 53 years, 68.2% females) were included. The most common indication for bypass was Moyamoya disease/syndrome (77.3%), and superficial temporal artery to middle cerebral artery bypass was the most common procedure (79.5%). Pretreatment modified Rankin Scales of 0 and 1 to 2 were noted in 11.4% and 59.1% of patients, respectively. Intraoperative imaging for bypass patency involved a combination of modalities; Doppler was the most used modality (90.9%) followed by indocyanine green and catheter angiography (86.4% and 61.4%, respectively). Qualitative TCUS assessment of graft patency was feasible in all cases. Postoperative inpatient TCUS confirmation of bypass patency was recorded in 56.8% of the cases, and outpatient TCUS surveillance was recorded in 47.7%. There were no cases of bypass failure necessitating retreatment. Similarly, no implant-related complications were encountered in the cohort. Major complications requiring additional surgery occurred in 2 patients (4.6%) including epidural hematoma requiring evacuation (2.3%) and postoperative surgical site infection (2.3%) that was believed to be unrelated to the implant. CONCLUSION:This multicenter study supports safety and feasibility of using sonolucent PMMA implant in EC-IC bypass surgery with the goal of monitoring bypass patency using TCUS.
PMID: 36929760
ISSN: 2332-4260
CID: 5533072

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Predictors of Clinical and Radiographic Failure from 636 Embolizations

Salem, Mohamed M; Kuybu, Okkes; Nguyen Hoang, Alex; Baig, Ammad A; Khorasanizadeh, Mirhojjat; Baker, Cordell; Hunsaker, Joshua C; Mendez, Aldo A; Cortez, Gustavo; Davies, Jason M; Narayanan, Sandra; Cawley, C Michael; Riina, Howard A; Moore, Justin M; Spiotta, Alejandro M; Khalessi, Alexander A; Howard, Brian M; Hanel, Ricardo; Tanweer, Omar; Levy, Elad I; Grandhi, Ramesh; Lang, Michael J; Siddiqui, Adnan H; Kan, Peter; Ogilvy, Christopher S; Gross, Bradley A; Thomas, Ajith J; Jankowitz, Brian T; Burkhardt, Jan-Karl
Background Knowledge regarding predictors of clinical and radiographic failures of middle meningeal artery (MMA) embolization (MMAE) treatment for chronic subdural hematoma (CSDH) is limited. Purpose To identify predictors of MMAE treatment failure for CSDH. Materials and Methods In this retrospective study, consecutive patients who underwent MMAE for CSDH from February 2018 to April 2022 at 13 U.S. centers were included. Clinical failure was defined as hematoma reaccumulation and/or neurologic deterioration requiring rescue surgery. Radiographic failure was defined as a maximal hematoma thickness reduction less than 50% at last imaging (minimum 2 weeks of head CT follow-up). Multivariable logistic regression models were constructed to identify independent failure predictors, controlling for age, sex, concurrent surgical evacuation, midline shift, hematoma thickness, and pretreatment baseline antiplatelet and anticoagulation therapy. Results Overall, 530 patients (mean age, 71.9 years ± 12.8 [SD]; 386 men; 106 with bilateral lesions) underwent 636 MMAE procedures. At presentation, the median CSDH thickness was 15 mm and 31.3% (166 of 530) and 21.7% (115 of 530) of patients were receiving antiplatelet and anticoagulation medications, respectively. Clinical failure occurred in 36 of 530 patients (6.8%, over a median follow-up of 4.1 months) and radiographic failure occurred in 26.3% (137 of 522) of procedures. At multivariable analysis, independent predictors of clinical failure were pretreatment anticoagulation therapy (odds ratio [OR], 3.23; P = .007) and an MMA diameter less than 1.5 mm (OR, 2.52; P = .027), while liquid embolic agents were associated with nonfailure (OR, 0.32; P = .011). For radiographic failure, female sex (OR, 0.36; P = .001), concurrent surgical evacuation (OR, 0.43; P = .009), and a longer imaging follow-up time were associated with nonfailure. Conversely, MMA diameter less than 1.5 mm (OR, 1.7; P = .044), midline shift (OR, 1.1; P = .02), and superselective MMA catheterization (without targeting the main MMA trunk) (OR, 2; P = .029) were associated with radiographic failure. Sensitivity analyses retained these associations. Conclusion Multiple independent predictors of failure of MMAE treatment for chronic subdural hematomas were identified, with small diameter (<1.5 mm) being the only factor independently associated with both clinical and radiographic failures. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Chaudhary and Gemmete in this issue.
PMID: 37070990
ISSN: 1527-1315
CID: 5466062

Middle meningeal artery embolization as a perioperative adjunct to surgical evacuation of nonacute subdural hematomas: An multicenter analysis of safety and efficacy

Salah, Walid K; Baker, Cordell; Scoville, Jonathan P; Hunsaker, Joshua C; Ogilvy, Christopher S; Moore, Justin M; Riina, Howard A; Levy, Elad I; Spiotta, Alejandro M; Jankowitz, Brian T; Michael Cawley, C; Khalessi, Alexander A; Tanweer, Omar; Hanel, Ricardo; Gross, Bradley A; Kuybu, Okkes; Hoang, Alex Nguyen; Baig, Ammad A; Khorasanizadeh, Mir Hojjat; Mendez, Aldo A; Cortez, Gustavo; Davies, Jason M; Narayanan, Sandra; Howard, Brian M; Lang, Michael J; Siddiqui, Adnan H; Thomas, Ajith; Kan, Peter; Burkhardt, Jan-Karl; Salem, Mohamed M; Grandhi, Ramesh
BACKGROUND:By 2030, nonacute subdural hematomas (NASHs) will likely be the most common cranial neurosurgery pathology. Treatment with surgical evacuation may be necessary, but the recurrence rate after surgery is as high as 30%. Minimally invasive middle meningeal artery embolization (MMAE) during the perioperative period has been posited as an adjunctive treatment to decrease the potential for recurrence after surgical evacuation. We evaluated the safety and efficacy of concurrent MMAE in a multi-institutional cohort. METHODS:Data from 145 patients (median age 73 years) with NASH who underwent surgical evacuation and MMAE in the perioperative period were retrospectively collected from 15 institutions. The primary outcome was the rate of recurrence requiring repeat surgical intervention. We collected clinical, treatment, and radiographic data at initial presentation, after evacuation, and at 90-day follow-up. Outcomes data were also collected. RESULTS:Preoperatively, the median hematoma width was 18 mm, and subdural membranes were present on imaging in 87.3% of patients. At 90-day follow-up, median NASH width was 6 mm, and 51.4% of patients had at least a 50% decrease of NASH size on imaging. Eight percent of treated NASHs had recurrence that required additional surgical intervention. Of patients with a modified Rankin Scale score at last follow-up, 87.2% had the same or improved mRS score. The total all-cause mortality was 6.0%. CONCLUSION/CONCLUSIONS:This study provides evidence from a multi-institutional cohort that performing MMAE in the perioperative period as an adjunct to surgical evacuation is a safe and effective means to reduce recurrence in patients with NASHs.
PMID: 36908233
ISSN: 2385-2011
CID: 5448782

Arachnoid Granulation Causing Unilateral Pulsatile Tinnitus Treated With Dural Venous Sinus Stenting

Gadot, Ron; Hoang, Alex N; Raper, Daniel M S; Sweeney, Alexander D; Juliano, Mario; Lustrin, Elizabeth; Tanweer, Omar
BACKGROUND:Large arachnoid granulations that protrude into dural venous sinuses and partially obstruct outflow are an underappreciated etiology of pulsatile tinnitus (PT). Endovascular dural venous sinus stenting is thought to diminish turbulent venous outflow and may relieve obstruction caused by arachnoid granulations. METHODS:Four patients at two institutions were evaluated for unilateral PT. Magnetic resonance imaging and digital subtraction angiography revealed moderate-to-severe stenoses from large arachnoid granulations within the implicated transverse sinus. All patients underwent venous manometry and endovascular sinus stenting. RESULTS:All patients experienced immediate and complete remission of their PT. Stenoses were relieved by a mean of 93% by Warfarin-Aspirin Symptomatic Intracranial Disease criteria. There were no procedural or periprocedural complications. All patients continued to report complete symptom resolution at a mean of 8-month follow-up. CONCLUSIONS:PT from arachnoid granulations are an underappreciated pathomechanism. Endovascular dural venous sinus stenting is an effective intervention for treating unilateral PT secondary to large arachnoid granulation.
PMID: 36509447
ISSN: 1537-4505
CID: 5381962

Surgical cytoreduction of deep-seated high-grade glioma through tubular retractor

Hajtovic, Sabastian; Sun, James; Multani, Jasjit S; Herrmann, Linda L; Britton, Hannah; Gautreaux, Jose; Tortolero, Lea; Harrison, Gillian; Golfinos, John G; Shepherd, Timothy M; Tanweer, Omar; Placantonakis, Dimitris G
OBJECTIVE:Maximal safe resection is the goal of surgical treatment for high-grade glioma (HGG). Deep-seated hemispheric gliomas present a surgical challenge due to safety concerns and previously were often considered inoperable. The authors hypothesized that use of tubular retractors would allow resection of deep-seated gliomas with an acceptable safety profile. The purpose of this study was to describe surgical outcomes and survival data after resection of deep-seated HGG with stereotactically placed tubular retractors, as well as to discuss the technical advances that enable such procedures. METHODS:This is a retrospective review of 20 consecutive patients who underwent 22 resections of deep-seated hemispheric HGG with the Viewsite Brain Access System by a single surgeon. Patient demographics, survival, tumor characteristics, extent of resection (EOR), and neurological outcomes were recorded. Cannulation trajectories and planned resection volumes depended on the relative location of white matter tracts extracted from diffusion tractography. The surgical plans were designed on the Brainlab system and preoperatively visualized on the Surgical Theater virtual reality SNAP platform. Volumetric assessment of EOR was obtained on the Brainlab platform and confirmed by a board-certified neuroradiologist. RESULTS:Twenty adult patients (18 with IDH-wild-type glioblastomas and 2 with IDH-mutant grade IV astrocytomas) and 22 surgeries were included in the study. The cohort included both newly diagnosed (n = 17; 77%) and recurrent (n = 5; 23%) tumors. Most tumors (64%) abutted the ventricular system. The average preoperative and postoperative tumor volumes measured 33.1 ± 5.3 cm3 and 15.2 ± 5.1 cm3, respectively. The median EOR was 93%. Surgical complications included 2 patients (10%) who developed entrapment of the temporal horn, necessitating placement of a ventriculoperitoneal shunt; 1 patient (5%) who suffered a wound infection and pulmonary embolus; and 1 patient (5%) who developed pneumonia. In 2 cases (9%) patients developed new permanent visual field deficits, and in 5 cases (23%) patients experienced worsening of preoperative deficits. Preoperative neurological or cognitive deficits remained the same in 9 cases (41%) and improved in 7 (32%). The median overall survival was 14.4 months in all patients (n = 20) and in the newly diagnosed IDH-wild-type glioblastoma group (n = 16). CONCLUSIONS:Deep-seated HGGs, which are surgically challenging and frequently considered inoperable, are amenable to resection through tubular retractors, with an acceptable safety profile. Such cytoreductive surgery may allow these patients to experience an overall survival comparable to those with more superficial tumors.
PMID: 36334293
ISSN: 1933-0693
CID: 5358912

Safety and efficacy of balloon-mounted stent in the treatment of symptomatic intracranial atherosclerotic disease: a multicenter experience

Mohammaden, Mahmoud H; Nogueira, Raul G; Tekle, Wondwossen; Ortega-Gutierrez, Santiago; Farooqui, Mudassir; Zevallos, Cynthia B; Hanel, Ricardo A; Cortez, Gustavo M; Aghaebrahim, Amin; Starke, Robert M; Aref, Hany; Elbassiouny, Ahmed; Gamea, Ayman; Alaraj, Ali; Sadeh, Morteza; Grigoryan, Mikayel; Kuybu, Okkes; Haussen, Diogo C; Sheth, Sunil A; Maud, Alberto; Cordina, Steve M; Tanweer, Omar; Kan, Peter; Burkhardt, Jan-Karl; Grandhi, Ramesh; Siddiq, Farhan; Hassan, Ameer E
BACKGROUND:Randomized clinical trials have failed to prove that the safety and efficacy of endovascular treatment for symptomatic intracranial atherosclerotic disease (ICAD) is better than that of medical management. A recent study using a self-expandable stent showed acceptable lower rates of periprocedural complications. OBJECTIVE:To study the safety and efficacy of a balloon-mounted stent (BMS) in the treatment of symptomatic ICAD. METHODS:Prospectively maintained databases from 15 neuroendovascular centers between 2010 and 2020 were reviewed. Patients were included if they had severe symptomatic intracranial stenosis in the target artery, medical management had failed, and they underwent intracranial stenting with BMS after 24 hours of the qualifying event. The primary outcome was the occurrence of stroke and mortality within 72 hours after the procedure. Secondary outcomes were the occurrence of stroke, transient ischemic attacks (TIAs), and mortality on long-term follow-up. RESULTS:A total of 232 patients were eligible for the analysis (mean age 62.8 years, 34.1% female). The intracranial stenotic lesions were located in the anterior circulation in 135 (58.2%) cases. Recurrent stroke was the qualifying event in 165 (71.1%) while recurrent TIA was identified in 67 (28.9%) cases. The median (IQR) time from the qualifying event to stenting was 5 (2-20.75) days. Strokes were reported in 13 (5.6%) patients within 72 hours of the procedure; 9 (3.9%) ischemic and 4 (1.7%) hemorrhagic, and mortality in 2 (0.9%) cases. Among 189 patients with median follow-up time 6 (3-14.5) months, 12 (6.3%) had TIA and 7 (3.7%) had strokes. Three patients (1.6%) died from causes not related to stroke. CONCLUSION/CONCLUSIONS:Our study has shown that BMS may be a safe and effective treatment for medically refractory symptomatic ICAD. Additional prospective randomized clinical trials are warranted.
PMID: 34349013
ISSN: 1759-8486
CID: 5005962