Endovascular Management of Medically Refractory Intracranial Arterial Stenosis

Abstract

Atherosclerotic intracranial arterial stenosis (ICAS) is one of the most common causes of stroke worldwide and is associated with a high risk of recurrent stroke. Patients with a recent transient ischemic attack (TIA) or stroke and severe stenosis (70 to 99% of the diameter of a major intracranial artery) are at particularly high risk for recurrent stroke in the territory of the stenotic artery (approximately 23% at 1 year) despite treatment with aspirin and standard management of vascular risk factors. Therefore, alternative therapies are urgently needed for these patients. Objective: Our study aimed to determine the efficacy and safety of angioplasty with stenting in medically refractory intracranial arterial stenosis. Methodology: The current study is a randomized prospective single center study carried out during the period from June 2016 to June 2018 at the Neuroendovascular Unit of El Mataria Teaching Hospital after obtaining an informed consent. Fifty patients were enrolled, randomized 1:1 and underwent twenty five stenting procedures and twenty five take medical treatment. The patients had been recruited from inpatient El Mataria Teaching Hospital admission and outpatient clinics. Results: Success rate in our study was 96 % where only one patient failed to deployment of stent due to tortuosity of Vessels. Restenosis occurred in one patient after stenting and complete occlusion occurred in one patient also so the percent of restenosis was 8%. Conclusion: Our study concluded that intracranial arterial stenting and best medical treatment superior in efficacy and safety than best medical treatment without stenting.