@article{8826e8bcaca54e8186e10e75cbcb2dc4,
title = "Endovascular Recanalization of Symptomatic Intracranial Arterial Stenosis Despite Aggressive Medical Management",
abstract = "Background: The optimal management of intracranial arterial stenosis is unclear, particularly in patients who have failed medical management. We report a multicenter real-world experience of endovascular recanalization of intracranial atherosclerotic stenosis refractory to aggressive medical therapy. Methods: Retrospective multicenter case series of consecutive endovascularly treated patients presenting with symptomatic (transient ischemic attack [TIA] or stroke) intracranial stenosis who had failed medical therapy. Patients were divided into 2 groups: patients with recurrent TIA or stroke despite medical management (group 1) versus patients presenting with a stroke and worsening symptoms (progressive or crescendo stroke) despite medical management (group 2). Results: A total of 101 patients were treated in 8 stroke centers from August 2009 to May 2017. Sixty-nine presented with recurrent TIA or stroke and 32 with stroke and worsening symptoms. Successful recanalization was achieved in 84% of patients. Periprocedural stroke occurred in 3 patients and 2 had a recurrent ischemic stroke at the 90-day follow-up. Symptomatic intraparenchymal hemorrhage secondary to reperfusion injury occurred in 3 patients and 1 had a hemorrhagic stroke after discharge. There were 2 periprocedural perforations that resulted in death. At 90 days, 86% of patients (64/74) did not have a recurrence of stroke and the 90-day cumulative ischemic stroke rate was 6.7% with 90-day mortality of 11.2%. The 90-day favorable outcome (modified Rankin Scale score, ≤2) rate was 77.5%. Conclusions: Endovascular recanalization of unstable intracranial atherosclerotic stenosis in patients who have failed medical therapy is feasible. Future randomized trials need to determine if recanalization is of any value for this population.",
keywords = "Angioplasty, Intracranial atherosclerosis, Stents, Stroke",
author = "Amin Aghaebrahim and Agnoletto, {Guilherme Jose} and Pedro Aguilar-Salinas and Granja, {Manuel F.} and Andre Monteiro and Siddiqui, {Adnan H.} and Levy, {Elad I.} and Hussain Shallwani and Kim, {Song J.} and Haussen, {Diogo C.} and Nogueira, {Raul G.} and Demetrius Lopes and Ahmed Saied and Jovin, {Tudor G.} and Jadhav, {Ashutosh P.} and Kaustubh Limaye and Turk, {Aquilla S.} and Spiotta, {Alejandro M.} and Chaudry, {Mohammad I.} and Turner, {Raymond D.} and Brasiliense, {Leonardo B.C.} and Dumont, {Travis M.} and Jacob Cherian and Peter Kan and Eric Sauvageau and Hanel, {Ricardo A.}",
note = "Funding Information: Conflict of interest statement: A.H.S. is a consultant for Amnis Therapeutics Ltd., Cerebrotech Medical Systems Inc., CereVasc LLC, Claret Medical Inc., Codman, Corindus Inc., GuidePoint Global Consulting, Medtronic, MicroVention, Neuravi, Penumbra, Pulsar Vascular, Rapid Medical, Rebound Therapeutics Corporation, Silk Road Medical, Stryker, The Stroke Project Inc., Three Rivers Medical Inc., Toshiba America Medical System Inc., and W.L. Gore & Associates and has financial interests in Buffalo Technology Partners Inc., Cardinal, Endostream Medical Ltd., International Medical Distribution Partners, Medina Medical Systems, Neuro Technology Investors, StimMed, and Valor Medical. E.I.L. receives an honorarium for training and lectures for Medtronic; is a national PI for Covidien–SWIFT Prime trials; is a shareholder for Intratech Medical Ltd., NeXtGen Biologics; is a consultant for Pulsar Vascular; is an AIS clinical advisor for Stryker; is a member of the advisory board for NeXtGen Biologics, MEDX, and Cognition Medical Corp; and gives carotid training for physicians in Abbott Vascular. D.L. is consultant for Stryker; is a member of the advisory board for Siemens; and is Principal Investigator in the SAMMPRIS trial. T.G.J. is a consultant for Silk Road Medical, Codman, and Neuravi; is a member of the advisory board for Anaconda Biomed, Route 92 Medical, Blockade, and FreeOx Biotech. A.S.T. is a consultant for Stryker, Medtronic, and Penumbra. A.M.S. is a consultant for MicroVention, Codman, and Penumbra. P.K. is a consultant for Stryker and Medtronic. R.A.H. is a consultant for Medtronic, Stryker, Codman, and MicroVention. The other authors report no conflicts. Publisher Copyright: {\textcopyright} 2018 Elsevier Inc.",
year = "2019",
month = mar,
doi = "10.1016/j.wneu.2018.12.008",
language = "English (US)",
volume = "123",
pages = "e693--e699",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
}