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Treatment of symptomatic high-grade intracranial stenoses with the balloon-expandable Pharos stent: initial experience

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

We report our first clinical experience with a CE-marked flexible monorail balloon-expandable stent for treatment of high-grade intracranial stenoses.

Methods

Between April 2006 and November 2007 21 patients with symptomatic intracranial stenoses (>70%) were treated with the PHAROS stent. In seven patients, the procedure was performed during acute stroke intervention. Procedural success, clinical complication rates and mid-term follow-up data were prospectively recorded.

Results

During a median follow-up period of 7.3 months one additional patient died of an unknown cause 3 months after the intervention. A patient with a significant residual stenosis presented with a new stroke after further progression of the residual stenosis. None of the successfully treated patients experienced ipsilateral stroke.

Conclusion

Recanalization of intracranial stenoses with the balloon-expandable Pharos stent is technically feasible. The periprocedural complication rate and mid-term follow-up results were in the range of previously reported case series. This pilot study was limited by the small sample size and severe morbidity of the included patients. Final evaluation of the efficacy of Pharos stent treatment demands further investigation.

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References

  1. Meyers PM, Schumacher HC, Tanji K, Higashida RT, Caplan LR (2007) Use of stents to treat intracranial cerebrovascular disease. Annu Rev Med 58:107–122

    Article  PubMed  CAS  Google Scholar 

  2. Higashida RT, Meyers PM, Connors JJ 3rd, Sacks D, Strother CM, Barr JD, Wojak JC, Duckwiler GR; American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Society of Neuroradiology (2005) Intracranial angioplasty & stenting for cerebral atherosclerosis: a position statement of the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, and the American Society of Neuroradiology. AJNR Am J Neuroradiol 26:2323–2327

    PubMed  Google Scholar 

  3. Berkefeld J, Hammann GF, du Mesnil R, Kurre W, Steinmetz H, Zanella FE, Sitzer M (2006) Endovascular treatment for intracranial stenoses – a common statement by neurologists and neuroradiologists. Nervenarzt 77(12):1444–1455

    Article  PubMed  CAS  Google Scholar 

  4. SSYLVIA Study Investigators (2004) Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results. Stroke 35:1388–1392

    Article  Google Scholar 

  5. du Mesnil de Rochemont, Turowski B, Buchkremer M, Sitzer M, Zanella FE, Berkefeld J (2004) Recurrent symptomatic high-grade intracranial stenoses: safety and efficacy of undersized stents – initial experience. Radiology 231:45–49

    Article  Google Scholar 

  6. Weber W, Mayer TE, Henkes H, Kis B, Hamann GF, Schulte-Altedornenburg G, Brückmann H, Kuehne D (2005) Stent-angioplasty of intracranial vertebral and basilar artery stenoses in symptomatic patients. Eur J Radiol 55:231–236

    Article  PubMed  Google Scholar 

  7. Yu W, Smith WS, Singh V, Ko NU, Cullen SP, Dowd CF, Halbach VV, Higashida RT (2005) Long-term outcome of endovascular stenting for symptomatic basilar artery stenosis. Neurology 64:1055–1057

    PubMed  CAS  Google Scholar 

  8. Chow MM, Masaryk TJ, Woo HH, Mayberg MR, Rasmussen PA (2005) Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: midterm analysis of clinical and radiologic predictors of neurological morbidity and mortality. AJNR Am J Neuroradiol 26(4):869–874

    PubMed  Google Scholar 

  9. Abou-Chebl A, Krieger DW, Gajzer CT, Yadav JS (2006) Intracranial angioplasty and stenting in the awake patient. J Neuroimaging 16(3):216–223

    PubMed  Google Scholar 

  10. Lylyk P, Vila JF, Miranda C, Ferrario A, Musacchio A, Rüfenacht D, Cohen JE (2005) Endovascular reconstruction by means of stent placement in symptomatic intracranial atherosclerotic stenosis. Neurol Res 27 [Suppl 1]:S84–S88

    Article  PubMed  Google Scholar 

  11. Jiang WJ, Srivastava T, Gao F, Du B, Dong KH, Xu XT (2006) Perforator stroke after elective stenting of symptomatic intracranial stenosis. Neurology 66:1868–1872

    Article  PubMed  CAS  Google Scholar 

  12. Jiang WJ, Du B, Leung TW, Xu XT, Jin M, Dong KH (2007) Symptomatic intracranial stenoses: cerebrovascular complications from elective stent placement. Radiology 243(1):188–197

    Article  PubMed  Google Scholar 

  13. Jiang WJ, Xu XT, Du B, Dong KH, Jin M, Wang QH, Ma N (2007) Comparison of elective stenting of severe versus moderate intracranial atherosclerotic stenosis. Neurology 68:420–426

    Article  PubMed  CAS  Google Scholar 

  14. Fiorella D, Chow MM, Anderson M, Woo H, Rassmussen PA, Masaryk TJ (2007) A 7-year experience with balloon mounted coronary stents for the treatment of symptomatic vertebrobasilar intracranial atheromatous disease. Neurosurgery 61:236–243

    Article  PubMed  Google Scholar 

  15. Levy EI, Turk A, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, Pride L, Purdy P, Welch B, Woo H, Rassmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella DJ (2007) Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management. Neurosurgery 61:644–651

    Article  PubMed  Google Scholar 

  16. Kasner SE, Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, Levine SR, Chatuverdi S, Benesch CG, Sila CA, Jovin TG, Romano JG, Cloft HJ; Warfarin Aspirin Symptomatic Intracranial Disease Trial Investigators (2006) Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 113:555–563

    Article  PubMed  Google Scholar 

  17. Mazighi M, Tanasescu R, Ducrocq X, Vicaut E, Bracard S, Houdart E, Woimant F (2006) Prospective study of symptomatic atherothrombotic intracranial stenoses – the GESICA study. Neurology 66:1187–1191

    Article  PubMed  CAS  Google Scholar 

  18. Thijs VN, Alberts GW (2000) Symptomatic intracranial atherosclerosis: outcome of patients who fail antithrombotic therapy. Neurology 55(4):490–497

    PubMed  CAS  Google Scholar 

  19. Henkes H, Miloslavki E, Lowens S, Reinatz J, Liebig T, Kühne D (2005) Treatment of intracranial atherosclerotic stenoses with balloon dilatation and self-expanding stent deployment (WingSpan). Neuroradiology 47:222–228

    Article  PubMed  CAS  Google Scholar 

  20. Bose A, Hartmann M, Henkes H, Liu HM, Teng MM, Szikora I, Berlis A, Reul J, Yu SC, Forsting M, Lui M, Lim W, Sit SP (2007) A novel, self expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses. Stroke 38:1531–1537

    Article  PubMed  CAS  Google Scholar 

  21. Freitas JM, Zenteno M, Aburto-Murrieta Y, Koppe G, Abath C, Nunes JA, Raupp E, Hidalgo R, Pieruccetti MA (2007) Intracranial arterial stenting for symptomatic stenoses: a Latin American experience. Surg Neurol 68:378–386

    Article  PubMed  Google Scholar 

  22. Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI (2000) A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 21(4):643–646

    PubMed  CAS  Google Scholar 

  23. US Food and Drug Administration (2008) Premarket Approval (PMA) Database, No. P030037. Center for Devices and Radiological Health. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMA/PMA.cfm?ID=2969

  24. Prabhakaran S, Wells KR, Lee VH, Flaherty CA, Lopes DK (2008) Prevalence and risk factors for aspirin and clopidogrel resistance in cerebrovascular stenting. AJNR Am J Neuroradiol 29:281–285

    PubMed  CAS  Google Scholar 

  25. Cruz-Flores S, Diamond AL (2006) Angioplasty for intracranial artery stenosis. Cochrane Database of Systematic Reviews, issue 3, article no.: CD004133. DOI 10.1002/14651858.CD004133.pub2

  26. Levy EI, Metha R, Gupta R, Hanel RA, Chamzuk AJ, Fiorella D, Woo HH, Albuquerque FC, Jovin TG, Horowitz MB, Hopkins LN (2007) Self-expanding stents for recanalization of acute cerebrovascular occlusions. AJNR Am J Neuroradiol 28(5):816–822

    PubMed  CAS  Google Scholar 

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Conflict of interest statement

Professor Berkefeld is principal investigator of the German Pharos registry and consultant of Micrus endovascular in this regard.

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Correspondence to W. Kurre.

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Kurre, W., Berkefeld, J., Sitzer, M. et al. Treatment of symptomatic high-grade intracranial stenoses with the balloon-expandable Pharos stent: initial experience. Neuroradiology 50, 701–708 (2008). https://doi.org/10.1007/s00234-008-0394-6

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  • DOI: https://doi.org/10.1007/s00234-008-0394-6

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