J Cerebrovasc Endovasc Neurosurg.  2013 Jun;15(2):85-95. 10.7461/jcen.2013.15.2.85.

Comparison of Drug-eluting Coronary Stents, Bare Coronary Stents and Self-expanding Stents in Angioplasty of Middle Cerebral Artery Stenoses

Affiliations
  • 1Department of Radiology, S-Jungang Hospital, Jeju, Republic of Korea.
  • 2Department of Neurosurgery, Donghae Dongin Hospital, Donghae, Republic of Korea.
  • 3Department of Neurology, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, Republic of Korea.
  • 4Department of Neurosurgery, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, Republic of Korea. y77y85@hanmail.net

Abstract


OBJECTIVE
The purpose of this study is to investigate the results of treatment using stent-angioplasty for symptomatic middle cerebral arterial (MCA) stenosis and comparison of in-stent restenosis between drug-eluting stents (DES), bare metal coronary stents (BMS) and self-expanding stents (SES).
MATERIALS AND METHODS
From Jan. 2007 to June. 2012, 34 patients (mean age +/- standard deviation: 62.9 +/- 13.6 years) with MCA stenosis were treated. Inclusion criteria were acute infarction or transient ischemic attacks (TIAs) and angiographically proven symptom related severe stenosis. Stents used for treatment were DES (n = 8), BMS (n = 13) and SES (n = 13). National Institutes of Health Stroke Scale (NIHSS) at admission was 2.5 +/- 3.1 and mean stenosis rate was 79.0 +/- 8.2%. Assessment of clinical and angiographic results was performed retrospectively.
RESULTS
Among 34 patients, periprocedural complications occurred in four cases (11.8%), however, only two cases (6.0%) were symptomatic. All patients were followed clinically (mean follow-up period; 40.7 +/- 17.7 months) and 31 were followed angiographically (91.2%. 13.4 +/- 8.5 months). There was no occurrence of repeat stroke in all patients; however, mild TIAs related to restenosis occurred in three of 34 patients (8.8%). The mean NIHSS after stent-angioplasty was 1.7 +/- 2.9 and 0.8 +/- 1.1 at discharge. The modified Rankin score (mRS) at discharge was 0.5 +/- 0.9 and 0.3 +/- 0.8 at the last clinical follow-up. In-stent restenosis over 50% occurred in five of 31 angiographically followed cases (16.1%), however, all of these events occurred only in patients who were treated with BMS or SES. Restenosis rate was 0.0% in the DES group and 20.8% in the other group (p = 0.562); it did not differ between BMS and SES (2/11 18.2%, 3/13 23.1%, p = 1.000).
CONCLUSION
Stent-angioplasty appears to be effective for symptomatic MCA stenosis. As for restenosis, in our study, DES was presumed to be more effective than BMS and SES; meanwhile, the results did not differ between the BMS and SES groups.

Keyword

Intracranial stenosis; Middle cerebral artery; Restenosis; Stent-angioplasty; Drug-eluting stent; Self-expanding stent

MeSH Terms

Angioplasty
Constriction, Pathologic
Drug-Eluting Stents
Follow-Up Studies
Humans
Infarction
Ischemic Attack, Transient
Middle Cerebral Artery
National Institutes of Health (U.S.)
Stents
Stroke

Figure

  • Fig. 1 Catheter angiograms of a 66-year-old male patient who presented with repeated transient ischemic attacks of left arm weakness. (A) Preoperative right internal cerebral artery (ICA) angiogram demonstrates severe stenosis at the right middle cerebral artery (MCA) and flow compromise of the MCA territory. (B) Right MCA was fully recanalized after Wingspan stent (Boston Scientific, Natick, MA, USA) deployment. (C) Follow-up angiogram three months after stent-angioplasty. M1 segment in which stent was implanted is more remodeled than immediately after stent-angioplasty. (D) Follow-up angiogram 13 months after stent-angioplasty. No change is seen when compared with the three month follow-up angiogram.

  • Fig. 2 Catheter angiograms of a 68-year-old female patient who presented with MCA borderzone infarct. (A) Preoperative left ICA angiogram demonstrates severe stenosis at M1 segment and definite flow compromise caused by the stenosis. (B) Postoperative angiogram after stent-angioplasty with a drug-eluting coronary stent (Endeavor, Medtronic Vascular, Santa Rosa, CA) shows no residual stenosis and fully recovered MCA flow. (C) One year follow-up angiogram shows no restenosis compared with immediate postoperative angiogram.

  • Fig. 3 Catheter angiograms of a 47-year-old male patient who presented with right MCA borderzone infarct. (A) Preoperative right ICA angiogram demonstrates MCA occlusion. (B) Postoperative angiogram after stent-angioplasty with a bare metal coronary stent (Coroflex, B. Braun, DE) shows no residual stenosis and fully recovered MCA flow. (C) Three month follow-up angiogram shows severe in-stent restenosis up to 80% with mild flow compromise. (D) Follow-up angiogram immediately after retreatment (balloon angioplasty) with a drug-eluting balloon (SeQuent® Please, B.Braun, DE) shows fully recovered MCA flow compromise, but insignificant residual stenosis remained. (E) One year follow-up angiogram after retreatment demonstrates a fully dilated M1 segment without any residual stenosis or restenosis.


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