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STENT TREATMENT OF INTRACRANIAL ATHEROSCLEROSIS - Update of the INTRASTENT registry - W. Kurre Klinik für Neuroradiologie - Alfried Krupp Krankenhaus Essen.

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Presentation on theme: "STENT TREATMENT OF INTRACRANIAL ATHEROSCLEROSIS - Update of the INTRASTENT registry - W. Kurre Klinik für Neuroradiologie - Alfried Krupp Krankenhaus Essen."— Presentation transcript:

1 STENT TREATMENT OF INTRACRANIAL ATHEROSCLEROSIS - Update of the INTRASTENT registry - W. Kurre Klinik für Neuroradiologie - Alfried Krupp Krankenhaus Essen J. Berkefeld Institut für Neuroradiologie - Goethe Universität Frankfurt FOR THE INTRASTENT STUDY GROUP

2 COINVESTIGATORS Universitätsklinik KielO. Jansen / M. Tietke AK Altona HamburgB. Eckert Universitätsklinik HamburgO. Wittkugel / J. Fiehler University of OxfordW. Küker Universitätsklinik GöttingenM. Knauth / S. Pilgram/ R. Schramm Universitätsklinik DüsseldorfB. Turowski Wedau Kliniken DuisburgF. Brassel / S. Schotes / D. Meila Helios Klinikum ErfurtJ. Klisch / V. Sychra Universitätsklinik DresdenR. v. Kummer / D. Mucha Universitätsklinik FrankfurtJ. Berkefeld / W. Kurre/ S. Kamek Universitätsklinik MainzW. Müller-Forell München Rechts der IsarTh. Liebig / F. Dorn Military Hosptial PragueJ. Maskova/ H. Parobkova Landesnervenklinik Wagner-Jauregg LinzJ. Trenkler / H. Haring Universitätsklinik GrazG. Klein / K. Niederkorn Papanikolaou General Hospital GreeceV. Katsaridis

3 INCLUSION CRITERIA 406 PATIENTS 418 STENOSES 407 PROCEDURES 160 PROSPECTIVE CASES PATIENT RELATED elective treatment patient clinically stable symptomatic lesion STENOSIS RELATED atherosclerotic petrous ICA – M1 V3 – basilar artery

4 LOCATION OF STENOSIS

5 TECHNICAL SUCCESS PROCEDUREn% NONE 40.1 PTA RESIDUAL STENOSIS >50% DESPITE STENT OVERALL SUCCESS: 89.7%

6 MORBIDITY / MORTALITY N =% MORTALITY 82.0 MAJOR STROKES (mRS 2) TIA AND MINOR STROKES (mRS 0 -1) % as per procedure

7 HEMORRHAGE death (%) disabeling stroke (%) non disabeling stroke/TIA (%) all (%) reperfusion22-4 vessel rupture1--1 wire perforation1-12 thrombolytics1--1 preexistent infarct-1-1 unkown3--3 all8 (2.0)3 (0.7)1 (0.2)12 (2.9) Significantly more hemorrhages for M1 stenoses compared to other locations!

8 ISCHAEMIA death (%) disabeling stroke (%) non disabeling stroke/TIA (%) all (%) side branch occlusion stent thrombosis-134 thrombembolic-336 not classified-358 all-14 (3.4) 28 (6.9) More perforator strokes in posterior circulation

9 OTHER death (%) disabeling stroke (%) non disabeling stroke/TIA (%) all (%) toxic contrast reaction -1-1 visual disturbance/ seizures --44 unknown--11 all-1 (0.2)5 (1.2)6 (1.5)

10 LOCATION OF STENOSIS Differences NOT statistically significant

11 DEVICES USED Significantly more SE in dICA and M1 More prospective data for SE

12 COMPLICATIONS - DEVICE - data not randomized - significantly more SE in dICA and M1 - more prospective data for SE p = for disabeling stroke and death

13 COMPLICATIONS - DEVICE - data not randomized - more prospective data for SE p = 0.23 and 0.2 for intra- and extradural BE vs. SE

14 CLINICAL FOLLOW UP (%) treated territory (%) unknown (%) other territory (%) TIA Major Stroke 5311 Minor Stroke 7511 all stroke 12 (4.6)8 (3.0)2 (0.8) FU rate 68.5% median FU 312 Tage

15 ANGIOGRAFIC FOLLOW UP Degree of stenosisn (%)symptomatic %123 > 70%132 occlusion21 27 (32.1)6 (7.1) retreatment11 (13.1) 22.6% control angiography selected patients!

16 SUMMARY disabeling stroke and death6.4% TIA and nondisabeling stroke4.9% - Increasing complication rates in intradural locations (n.s.) - significantly more hemorrhages in treatment of M1 stenoses - complication rates for SES higher for intra- and extradural locations (n.s., bias!) ipsilateral stroke rate FU3% (CAVE: 68.5% follow up, median 312 days) rate of restenosis32.1% (CAVE: 22.6% follow up)


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