Introduction
Intracranial stenosis (IS), the narrowing of arteries within the brain, is a significant risk factor for ischemic stroke, a leading cause of disability and mortality worldwide. Timely and efficient treatment is paramount for patients suffering from IS. A recent study published in the Journal of Neuroradiology sheds new light on an ongoing debate within the medical community regarding the most effective and safe method for deploying the Neuroform Atlas stent in IS treatment. The retrospective study comparatively assessed the outcomes of the Atlas stent placement via a Gateway balloon catheter and a standard microcatheter, with remarkable insights into residual stenosis and incidences of in-stent restenosis (ISR).
DOI: 10.1016/j.neurad.2024.01.001
Keywords
1. Intracranial stenosis treatment
2. Neuroform Atlas stent
3. Gateway balloon catheter
4. In-stent restenosis
5. Ischemic stroke prevention
Intracranial stenosis, a condition characterized by the narrowing of cerebral arteries, can significantly increase the risk of ischemic stroke. The treatment landscape for IS suffered from a scarcity of reliable and safe techniques until the advent of stents explicitly designed for cerebral arteries, like the Neuroform Atlas. However, the optimal deployment method to ensure both safety and efficacy has remained a topic of research and discussion.
The Journal of Neuroradiology, a renowned academic journal in the field of neuroimaging and intervention, has published a compelling study from the Department of Neurovascular Disease at Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, China. The article, titled “Comparison of the safety and efficacy of Neuroform Atlas stent deployed via Gateway balloon catheter and microcatheter for the treatment of intracranial stenosis,” presents findings that could influence clinical practices and patient outcomes considerably.
Study Design and Methods
Under the leadership of the study’s corresponding author, Dr. Yibin Fang, the research team conducted a comparative analysis on two distinct methods of delivering the Neuroform Atlas stent to treat IS. They retrospectively reviewed 33 procedures where the stents were deployed using either the Gateway balloon catheter (in 19 cases, amounting to 57.6%) or a standard microcatheter (in 14 cases, totalling 42.4%). The primary focus of the study was to evaluate the safety, determined by the rate of post-procedural stroke or death within one month, and efficacy, assessed by the ISR rate. Additionally, the researchers looked into the relationship between ISR and residual stenosis.
Results and Findings
The study’s findings are striking. With follow-up imaging data available for 26 patients, the incidence of ISR was documented at 15.4%. This occurrence was higher, although not statistically significantly so, in the microcatheter group in comparison to the Gateway group (30.0% vs. 6.25%, P = .39). Clinical follow-up data for 30 patients revealed a one-month post-procedural stroke rate of 3.3% and a follow-up rate between one month and one year of 13.3%. Similar to ISR, the occurrence of stroke within one month was higher in the microcatheter group but was not statistically significant (7.7% vs. 0%, P = .43).
However, when examining strokes in the same territory as the procedure, the Gateway group exhibited a significantly lower rate than the microcatheter group, with figures standing at 0% versus 30.8% (P = .026) respectively. This observation argues in favor of the Gateway method when considering safety aspects related to territory-specific stroke risks.
Moreover, researchers noted a higher incidence of residual stenosis of less than 30% in the non-ISR group when compared to the ISR group (72.2% vs. 0%, P = .014), suggesting that the degree of residual stenosis may be a predictive factor for ISR.
Discussion and Implications
The implications of this study are far-reaching. The Atlas stent, which is specially designed for the intricate and delicate cerebral vasculature, is a critical tool in preventing strokes caused by IS. The distinct difference in post-procedural territory-specific stroke rates strongly suggests that deployment via the Gateway balloon catheter might offer a safer profile than using a microcatheter.
This finding bears significant weight in the decision-making process for neurointerventionalists who aim to mitigate the risk of further complications. Given that any occurrence of stroke can have devastating consequences, favoring a method with a lower associated risk is of utmost clinical importance.
Another vital observation from the study is the association between residual stenosis and ISR. The seemingly protective effect of a mild degree of stenosis (less than 30%) against ISR invites further research into the optimal calibration of stent deployment to guard against restenosis while not compromising arterial patency.
Limitations and Future Investigations
While this study’s contributions are invaluable, it possesses some limitations, including its retrospective nature and relatively small sample size. Prospective, randomized controlled trials with larger cohorts are needed to validate these results further and potentially influence practice guidelines.
The study also opens avenues for research on patient-specific factors that could contribute to the different safety and efficacy profiles observed between the two methods. There may be unexplored benefits or drawbacks to each technique that could enhance individualized treatment strategies for IS.
Conclusion
The study by Dr. Yibin Fang and colleagues represents a stride toward improved safety in the management of intracranial stenosis. The use of the Gateway balloon catheter for Neuroform Atlas stent deployment reflects a lower incidence of territory-specific post-procedural strokes, offering a safer route for patients. As the quest for the ideal treatment of IS continues, this research underlines the importance of carefully selecting the method of stent delivery, considering the potential for residual stenosis and individual patient parameters.
The promise of a future where the devastating impacts of ischemic stroke are greatly diminished seems a little closer, thanks to the relentless pursuit of medical research in neuroradiology.
References
1. Zhu, D., Qi, D., Cao, W., Hu, R., Zhang, K., Song, T., Ma, P., Zheng, T., & Fang, Y. (2024). Comparison of the safety and efficacy of Neuroform Atlas stent deployed via Gateway balloon catheter and microcatheter for the treatment of intracranial stenosis. Journal of Neuroradiology, 10.1016/j.neurad.2024.01.001
2. Goyal, N., Tsivgoulis, G., Iftikhar, S., Khorchid, H., Pandhi, A., Ishfaq, M. F., Maragkos, G. A., & Alexandrov, A. V. (2018). S0afety and efficacy of Neuroform Atlas stent in wide-necked intracranial aneurysm treatment: A systematic review and meta-analysis. World Neurosurgery, 116, e933-e943.
3. Alexander, M. J., Zauner, A., Chaloupka, J. C., Baxter, B., Callison, R. C., Gupta, R., & Hanel, R. A. (2019). WEAVE trial: Final results in 152 on-label patients. Stroke, 50(4), 889-894.
4. Grunwald, I. Q., Papanagiotou, P., Politi, M., Krick, C., Gul, G., & Reith, W. (2015). Balloon angioplasty and stenting in carotid and vertebral artery dissections: A systematic review of the literature. Neuroradiology, 57(7), 655-661.
5. Berkhemer, O. A., Jansen, I. G., Beumer, D., Fransen, P. S., van den Berg, L. A., Yoo, A. J., & van Zwam, W. H. (2017). Collateral status on baseline computed tomographic angiography and intra-arterial treatment effect in patients with proximal anterior circulation occlusion. Stroke, 48(3), 768-776.