Post-stenting angiographic evaluation of the treated artery in AP and lateral projections was performed to evaluate revascularization of the stented arterial segment as well as to assess for thrombo-embolic complications. A stent diameter slightly oversized compared to the normal segment of the target artery was utilized. Next, a Wingspan stent (Stryker Neurovascular) was deployed across the segment of severe stenosis. Following the angioplasty, a repeat angiogram of the treated artery was obtained in AP and lateral projections to assess the vessel diameter. A slightly undersized balloon catheter diameter as compared to the normal arterial segment diameter was used for angioplasty. A Gateway PTA balloon catheter (Stryker Neurovascular, Salt Lake City, UT, USA) was advanced over a 0.014 inch diameter, 300 cm long microwire and balloon angioplasty was performed across the stenotic segment. Selective angiogram of the target artery was performed in AP and lateral projections to confirm the severity of stenosis. Patients were heparinized to a goal activated clotting time of 250 seconds. Vascular access was obtained via right common femoral artery puncture via a 6 French sheath. Both groins were prepped and draped in sterile fashion. General anesthesia via endotracheal intubation was used for all patients. Informed written consent was obtained from all patients included in this report. Therefore, it is possible that at least some of the failures in the intracranial stenting group may be due to suboptimal patient selection.
Icad stroke trial#
However, the SAMMPRIS trial has faced criticism for enrolling patients mostly based on severity of stenosis without considering important factors such as the mechanism of stroke, potential compromise of distal blood flow, status of collateral supply, and brain perfusion. The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial concluded that aggressive medical management is superior to percutaneous transluminal angioplasty and stenting. Current management approaches to ICAD include aggressive medical management with dual antiplatelet agents and control of risk factors, as well as percutaneous transluminal angioplasty and stenting. The overall risk of suffering stroke due to intracranial stenosis is between 7 and 24%. Intracranial atherosclerotic disease (ICAD) accounts for 8-10% of cases that lead to ischemic stroke in the United States, and rises up to as high as 33% in the Asian population. Ischemic stroke is the second leading cause of mortality worldwide and the number one cause of adult disability.
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