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
UHR
EUROPA AUDITORIUM
10 min Vortrag
5 min Diskussion

2. COINVESTIGATORS Universitätsklinik Kiel O. Jansen / M. Tietke
AK Altona Hamburg B. Eckert
Universitätsklinik Hamburg O. Wittkugel / J. Fiehler
University of Oxford W. Küker
Universitätsklinik Göttingen M. Knauth / S. Pilgram / R. Schramm
Universitätsklinik Düsseldorf B. Turowski
Wedau Kliniken Duisburg F. Brassel / S. Schotes / D. Meila
Helios Klinikum Erfurt J. Klisch / V. Sychra
Universitätsklinik Dresden R. v. Kummer / D. Mucha
Universitätsklinik Frankfurt J. Berkefeld / W. Kurre/ S. Kamek
Universitätsklinik Mainz W. Müller-Forell
München Rechts der Isar Th. Liebig / F. Dorn
Military Hosptial Prague J. Maskova / H. Parobkova
Landesnervenklinik Wagner-Jauregg Linz J. Trenkler / H. Haring
Universitätsklinik Graz G. Klein / K. Niederkorn
Papanikolaou General Hospital Greece V. Katsaridis

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

4. LOCATION OF STENOSIS

5. TECHNICAL SUCCESS OVERALL SUCCESS: 89.7% PROCEDURE n % NONE PTA4
0.1
PTA 13
3.1
RESIDUAL STENOSIS >50% DESPITE STENT 26
6.2
Kriterien für technischen Erfolg:
Stent plazierbar
Reststenose < 50%
OVERALL SUCCESS: 89.7%

6. MORBIDITY / MORTALITY 8 2.0 18 4.4 20 4.9 N = % MORTALITY
MAJOR STROKES
(mRS  2) 18
4.4
TIA AND MINOR STROKES
(mRS 0 -1) 20
4.9
407 Prozeduren
% as per procedure

7. HEMORRHAGE 8 (2.0) 3 (0.7) 1 (0.2) 12 (2.9) death (%)
disabeling stroke
non
disabeling stroke/TIA
all
reperfusion 2 - 4
vessel rupture 1
wire perforation
thrombolytics
preexistent infarct
unkown 3
8 (2.0)
3 (0.7)
1 (0.2)
12 (2.9)
407 Prozeduren
Significantly more hemorrhages for M1 stenoses compared to other locations!

8. ISCHAEMIA 14 (3.4) 28 (6.9) death (%) disabeling stroke non
disabeling stroke/TIA
all
side branch occlusion - 7 3 10
stent thrombosis 1 4
thrombembolic 6
not classified 5 8
14 (3.4)
28 (6.9)
407 Prozeduren
More perforator strokes in posterior circulation

9. OTHER 1 (0.2) 5 (1.2) 6 (1.5) death (%) disabeling stroke non
disabeling stroke/TIA
all
toxic contrast reaction - 1
visual disturbance/
seizures 4
unknown
1 (0.2)
5 (1.2)
6 (1.5)
407 Prozeduren

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 TIA11 6 1 4
Major Stroke 5 3
Minor Stroke 7
∑ all stroke
12 (4.6)
8 (3.0)
2 (0.8)
384 successful stent treatments alive after treatment
121 lost to follow up
FU rate 68.5%
% stroke berechnet für 263 patienten mit follow up
FU rate 68.5%
median FU 312 Tage

15. ANGIOGRAFIC FOLLOW UP 22.6% control angiography selected patients!
Degree of stenosis
n (%)
symptomatic % 12 3
> 70% 13 2
occlusion 1 ∑
27 (32.1)
6 (7.1)
retreatment
11 (13.1)
84 Reangiografien
Symptomatisch mit TIA oder Stroke

16. disabeling stroke and death 6.4% TIA and nondisabeling stroke 4.9%
SUMMARY
disabeling stroke and death 6.4%
TIA and nondisabeling stroke 4.9%
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 FU 3%
(CAVE: 68.5% follow up, median 312 days)
rate of restenosis %
(CAVE: 22.6% follow up)