Technology assessment document
Reporting Standards for Angioplasty and Stent-assisted Angioplasty for Intracranial Atherosclerosis

https://doi.org/10.1016/j.jvir.2009.03.005Get rights and content

Background and Purpose

Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients. Technological advances over the past 10 years have enabled endovascular treatment of intracranial atherosclerotic stenosis. The number of patients treated with angioplasty or stent-assisted angioplasty for this condition is increasing. Given the lack of universally accepted definitions, the goal of this document is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting clinical and radiological evaluation, technique, and outcome of endovascular treatment using angioplasty or stent-assisted angioplasty for stenotic and occlusive intracranial atherosclerosis.

Summary of Report

This article was written under the auspices of Joint Writing Group of the Technology Assessment Committee, Society of NeuroInterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebrovascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and the Section of Stroke and Interventional Neurology of the American Academy of Neurology. A computerized search of the National Library of Medicine database of literature (PubMed) from January 1997 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data in stenotic intracranial atherosclerosis that could be used as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This document offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of intracranial stenotic and occlusive atherosclerosis. Included in this guidance document are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should also be helpful in clinical practice and applicable to all publications.

Conclusion

In summary, the definitions proposed represent recommendations for constructing useful research data sets. The intent is to facilitate production of scientifically rigorous results capable of reliable comparisons between and among similar studies. In some cases, the definitions contained here are recommended by consensus of a panel of experts in this writing group for consistency in reporting and publication. These definitions should allow different groups to publish results that are directly comparable.

Section snippets

Background

Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients. In the United States, it is estimated that 40 000 to 60 000 first-ever and recurrent strokes are caused by intracranial cerebral atherosclerosis annually. Typical risk factors are insulin-dependent diabetes mellitus, hypertension, smoking, and hypercholesterolemia. The pathology of intracranial atherosclerosis is similar to other vascular territories (1). There seems to be a racial preference for

Purpose

It is the purpose of this document to review indications and reporting of cerebral endovascular treatment procedures for stenotic intracranial atherosclerosis. This document includes currently available scientific data on endovascular cerebrovascular procedures for this disease entity. The document may therefore be useful at the institutional level: (1) to characterize the expected success and complication rates for neurovascular interventional procedures when performed by highly skilled

Conclusion

Endovascular revascularization for intracranial atherosclerosis is an emerging new treatment option for symptomatic patients. Symptomatic patients are defined as those with transient ischemic attacks or ischemic strokes in the territory of the stenotic artery. As technology is emerging, the number of patients treated is increasing and will continue to increase. Standardized reporting of the clinical experience across different institutions assures comparability of results to define the benefits

References (180)

  • Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results

    Stroke

    (2004)
  • A. Bose et al.

    A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenosesThe Wing Span Study

    Stroke

    (2007)
  • R.T. Higashida et al.

    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

    (2005)

  • Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis

  • C. Kremer et al.

    Prognosis of asymptomatic stenosis of the middle cerebral artery

    J Neurol Neurosurg Psychiatry

    (2004)
  • F.I. Mahoney et al.

    Functional evaluation: the Barthel Index

    Md State Med J

    (1965)
  • R. de Haan et al.

    The clinical meaning of Rankin 'handicap' grades after stroke

    Stroke

    (1995)
  • T. Brott et al.

    Measurements of acute cerebral infarction: a clinical examination scale

    Stroke

    (1989)

  • Stroke Scales & Clinical Assessment Tools

  • NIH Stroke Scale Training

  • J.T. Wilson et al.

    Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale

    Stroke

    (2002)
  • K.R. Lees et al.

    NXY-059 for acute ischemic stroke

    N Engl J Med

    (2006)
  • H. Naritomi et al.

    Effect of chronic middle cerebral artery stenosis on the local cerebral hemodynamics

    Stroke

    (1985)
  • C.P. Derdeyn et al.

    Hemodynamic effects of middle cerebral artery stenosis and occlusion

    AJNR Am J Neuroradiol

    (1998)
  • P. Castaigne et al.

    Arterial occlusions in the vertebro-basilar systemA study of 44 patients with post-mortem data

    Brain

    (1973)
  • P. Constantinides

    Pathogenesis of cerebral artery thrombosis in man

    Arch Pathol

    (1967)
  • F. Lhermitte et al.

    Nature of occlusions of the middle cerebral artery

    Neurology

    (1970)
  • J. Ogata et al.

    Mechanisms of cerebral artery thrombosis: a histopathological analysis on eight necropsy cases

    J Neurol Neurosurg Psychiatry

    (1994)
  • S. Sadoshima et al.

    Cerebral artery thrombosis and intramural hemorrhage

    Stroke

    (1979)
  • R.C. Hinton et al.

    Symptomatic middle cerebral artery stenosis

    Ann Neurol

    (1979)
  • R.N. Corston et al.

    Prognosis in middle cerebral artery stenosis

    Stroke

    (1984)
  • W.J. Koroshetz et al.

    Artery-to-artery embolism causing stroke in the posterior circulation

    Neurology

    (1987)
  • J. Masuda et al.

    Artery-to-artery embolism from a thrombus formed in stenotic middle cerebral arteryReport of an autopsy case

    Stroke

    (1987)
  • T. Segura et al.

    Embolism in acute middle cerebral artery stenosis

    Neurology

    (2001)
  • K.S. Wong et al.

    A pilot study of microembolic signals in patients with middle cerebral artery stenosis

    J Neuroimaging

    (2001)
  • C.M. Fisher et al.

    Basilar artery branch occlusion: a cause of pontine infarction

    Neurology

    (1971)
  • C.M. Fisher

    Bilateral occlusion of basilar artery branches

    J Neurol Neurosurg Psychiatry

    (1977)
  • J. Bogousslavsky et al.

    Atherosclerotic disease of the middle cerebral artery

    Stroke

    (1986)
  • L. Caplan et al.

    Occlusive disease of the middle cerebral artery

    Neurology

    (1985)
  • P.A. Lyrer et al.

    Cerebral infarcts related to isolated middle cerebral artery stenosis

    Stroke

    (1997)
  • M. Mull et al.

    Cerebral hemispheric low-flow infarcts in arterial occlusive diseaseLesion patterns and angiomorphological conditions

    Stroke

    (1997)
  • R.A. Felberg et al.

    Screening for intracranial stenosis with transcranial Doppler: the accuracy of mean flow velocity thresholds

    J Neuroimaging

    (2002)
  • T. Hirai et al.

    Prospective evaluation of suspected stenoocclusive disease of the intracranial artery: combined MR angiography and CT angiography compared with digital subtraction angiography

    AJNR Am J Neuroradiol

    (2002)
  • S. Bash et al.

    Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography

    AJNR Am J Neuroradiol

    (2005)
  • W.A. Willinek et al.

    Noninvasive detection of steno-occlusive disease of the supra-aortic arteries with three-dimensional contrast-enhanced magnetic resonance angiography: a prospective, intra-individual comparative analysis with digital subtraction angiography

    Stroke

    (2005)
  • V.L. Wright et al.

    Assessment of CE-MRA for the rapid detection of supra-aortic vascular disease

    Neurology

    (2005)
  • J.P. Villablanca et al.

    3 T contrast-enhanced magnetic resonance angiography for evaluation of the intracranial arteries: comparison with time-of-flight magnetic resonance angiography and multislice computed tomography angiography

    Invest Radiol

    (2006)
  • E. Feldmann et al.

    The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trial

    Neurology

    (2007)
  • C.P. Derdeyn et al.

    Cerebral hemodynamic impairment: methods of measurement and association with stroke risk

    Neurology

    (1999)
  • M. Furukawa et al.

    Evaluation of cerebral perfusion parameters measured by perfusion CT in chronic cerebral ischemia: comparison with xenon CT

    J Comput Assist Tomogr

    (2002)

    • Cited by (7)

    View all citing articles on Scopus

    Dr Higashida served as a consultant to Cordis Neurovascular. Dr Nesbit received honoraria from Cordis Neurovascular and Genentech, has an ownership interest in Concentric Medical, and served as a consultant to Concentric Medical. Dr Wechsler served as a consultant to Nuevelo, Inc, and Abbott Vascular. Dr Lavine received honoraria from Cordis Neurovascular. Dr Rasmussen received honoraria from the Universities of Minnesota and Pittsburgh, Microvention/Terumo, ev3, Possis, Medical/Medrad, and Micrus, has an ownership interest in Chestnut Medical, and served as a consultant to Chestnut Medical.

    Published in Stroke. 2009;40(5):e348–e365.

    Published online before print February 26, 2009, doi: 10.1161/STROKEAHA.108.527580.

    View full text
    Copyright © 2009 American Heart Association, Inc. Published by Elsevier Inc. All rights reserved.