Long-Term Evolutionary Change in the Lumen of Intracranial Atherosclerotic Stenosis Following Angioplasty and Stenting
| Autor: | Thomas W. Leung, Kwok Tung Lee, Lawrence K.S. Wong, Tiffany Wing Wa Lau, Simon C.H. Yu, Simon Sin Man Wong |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Ischemia Lumen (anatomy) Constriction Pathologic 030204 cardiovascular system & hematology Brain Ischemia 03 medical and health sciences Imaging Three-Dimensional 0302 clinical medicine Recurrence Interquartile range Internal medicine Angioplasty medicine Humans Aged Retrospective Studies Computed tomography angiography medicine.diagnostic_test business.industry Cone-Beam Computed Tomography Middle Aged Intracranial Arteriosclerosis medicine.disease Cerebral Angiography Stroke Stenosis Treatment Outcome Rotational angiography Angiography Cardiology Blood Vessels Female Stents Surgery Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Operative Neurosurgery. 14:128-138 |
| ISSN: | 2332-4260 2332-4252 |
| DOI: | 10.1093/ons/opx097 |
| Popis: | BACKGROUND Angioplasty and stenting is a recognized treatment option for patients with intracranial atherosclerosis. OBJECTIVE To evaluate the long-term evolutionary luminal changes of intracranial atherosclerosis after angioplasty and stenting. METHODS This was a retrospective study with patient consent. Eighty-two patients presenting with acute and minor cerebral ischemia due to stenosis ≥70%, who had received medical therapy with or without stenting (Wingspan), were invited. Luminal imaging was provided using 3-dimensional rotational angiography (3-DRA) at baseline and 12 mo, and cone-beam computed tomography angiography with intravenous contrast (CBCT) was provided at follow-up (median 82.4 mo [interquartile range 61.9-96.9 mo]). RESULTS Thirty-six patients in the stenting group and 26 patients in the medical group were recruited and completed the study. There was no statistically significant difference in demographics between the 2 patient groups. The luminal gain at 12 or 80 mo as compared to baseline in the stenting group was significantly greater than that in the medical group (12 mo: median gain 30% vs 7.2%, P < .001; 80 mo: median gain 42.9% vs 7.2%, P < .0001). Luminal loss or unchanged lumen was correlated with recurrent ischemic event. The differences in the stenosis degree assessment between CBCT and 3-DRA in the same 10 patients with or without stenting were 1.2 ± 0.6% or 0.2 ± 0.06%, respectively. There was a correlation between recurrent ischemic events and luminal loss. CONCLUSION Arterial lumen after angioplasty and stenting can probably be well maintained and delayed luminal gain does occur, long-term luminal loss is associated with recurrent ischemic events, CBCT might be useful as a less-invasive means for long-term assessment. |
| Databáze: | OpenAIRE |
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