STENT TREATMENT OF INTRACRANIAL ATHEROSCLEROSIS

- Update of the INTRASTENT registry -

W. KurreKlinik für Neuroradiologie - Alfried Krupp Krankenhaus Essen

J. BerkefeldInstitut für Neuroradiologie - Goethe Universität Frankfurt

FOR THE INTRASTENT STUDY GROUP

07.10.2010

COINVESTIGATORS

Universitätsklinik Kiel O. Jansen / M. Tietke

AK Altona Hamburg B. Eckert

Universitätsklinik Hamburg O. Wittkugel / J. Fiehler

University of Oxford W. Küker

Universitätsklinik Göttingen M. Knauth / S. Pilgram / R. Schramm

Universitätsklinik Düsseldorf B. Turowski

Wedau Kliniken Duisburg F. Brassel / S. Schotes / D. Meila

Helios Klinikum Erfurt J. Klisch / V. Sychra

Universitätsklinik Dresden R. v. Kummer / D. Mucha

Universitätsklinik Frankfurt J. Berkefeld / W. Kurre/ S. Kamek

Universitätsklinik Mainz W. Müller-Forell

München Rechts der Isar Th. Liebig / F. Dorn

Military Hosptial Prague J. Maskova/ H. Parobkova

Landesnervenklinik Wagner-Jauregg Linz J. Trenkler / H. Haring

Universitätsklinik Graz G. Klein / K. Niederkorn

Papanikolaou General Hospital Greece V. Katsaridis

INCLUSION CRITERIA

406 PATIENTS

418 STENOSES

407 PROCEDURES

160 PROSPECTIVE CASES

PATIENT RELATED

• elective treatment

• patient clinically stable

• symptomatic lesion

STENOSIS RELATED

• atherosclerotic

• petrous ICA – M1

• V3 – basilar artery

LOCATION OF STENOSIS

TECHNICAL SUCCESS

PROCEDURE n %

NONE 4 0.1

PTA 13 3.1

RESIDUAL STENOSIS >50% DESPITE STENT

26 6.2

OVERALL SUCCESS: 89.7%

MORBIDITY / MORTALITY

N = %

MORTALITY 8 2.0

MAJOR STROKES

(mRS 2)18 4.4

TIA AND MINOR STROKES

(mRS 0 -1)20 4.9

% as per procedure

HEMORRHAGE

death

(%)

disabeling stroke

(%)

nondisabeling stroke/TIA(%)

all

(%)

reperfusion 2 2 - 4

vessel rupture 1 - - 1

wire perforation 1 - 1 2

thrombolytics 1 - - 1

preexistent infarct - 1 - 1

unkown 3 - - 3

all 8 (2.0) 3 (0.7) 1 (0.2) 12 (2.9)

Significantly more hemorrhages for M1 stenoses compared to other locations!

ISCHAEMIA

death

(%)

disabeling stroke

(%)

nondisabeling stroke/TIA(%)

all

(%)

side branch occlusion

- 7 3 10

stent thrombosis - 1 3 4

thrombembolic - 3 3 6

not classified - 3 5 8

all - 14 (3.4) 14 (3.4) 28 (6.9)

More perforator strokes in posterior circulation

OTHER

death

(%)

disabeling stroke

(%)

nondisabeling stroke/TIA(%)

all

(%)

toxic contrast reaction

- 1 - 1

visual disturbance/seizures

- - 4 4

unknown - - 1 1

all - 1 (0.2) 5 (1.2) 6 (1.5)

LOCATION OF STENOSIS

Differences NOT statistically significant

DEVICES USED

Significantly more SE in dICA and M1More prospective data for SE

COMPLICATIONS - DEVICE

- data not randomized- significantly more SE in dICA and M1- more prospective data for SEp = 0.054 for disabeling stroke and death

COMPLICATIONS - DEVICE

- data not randomized- more prospective data for SEp = 0.23 and 0.2 for intra- and extradural BE vs. SE

CLINICAL FOLLOW UP

∑

(%)

treated territory

(%)

unknown

(%)

other

territory

(%)

TIA 11 6 1 4

Major Stroke 5 3 1 1

Minor Stroke 7 5 1 1

∑ all stroke 12 (4.6) 8 (3.0) 2 (0.8) 2 (0.8)

FU rate 68.5%

median FU 312 Tage

ANGIOGRAFIC FOLLOW UP

Degree of stenosis n (%) symptomatic

50 - 70% 12 3

> 70% 13 2

occlusion 2 1

∑ 27 (32.1) 6 (7.1)

retreatment 11 (13.1)

22.6% control angiography

selected patients!

SUMMARY

disabeling stroke and death 6.4%TIA and nondisabeling stroke 4.9%

- Increasing complication rates in intradural locations (n.s.)- significantly more hemorrhages in treatment of M1 stenoses- complication rates for SES higher for intra- and extradural locations (n.s.,

bias!)

ipsilateral stroke rate FU 3%

(CAVE: 68.5% follow up, median 312 days)

rate of restenosis 32.1%

(CAVE: 22.6% follow up)