| Part one:Application of the Enterprise stent in symptomatic intracranial arterial stenosisObjective:In the background of SAMMPRIS be terminated in advance, we assessed the safety and effectiveness of the Enterprise stent in treating atherosclerotic intracranial arterial stenosis(AIAS).Method:This was a retrospective study performed in AIAS patients Who received the Enterprise stenting at the Department of Neurosurgery, Second Hospital of Shandong University between June 2012 and June 2014. All patients were prescribed with medication of clopidogrel and aspirin for anti-platelet aggregation therapy before and after the operation. Patients were assessed by MRS when discharged, and the observations indices were collected in detail. Clinical follow-ups and digital subtraction angiography (DSA) were performed at 1,3,6 and 12 months postoperatively. Univariate and multivariate analyses were performed to evaluate the independent risk factor for in-stent restenosis(ISR).Results:Sixty AIAS patients with 62 lesions were enrolled. There were 42 men and 18 women with a mean age of 56.8±8.0 years. Fourteen lesions (22.6%) were at the anterior and 48 (77.4%) were at the posterior circulation. Mean stenosis rate was 76.3±12.7%, mean stenotic vessel length was 7.7±2.0mm. The technical success rate was 100%. The mean post-stent residual stenosis rate was 22.8±4.8%. Five patients (8.3%) had perioperative complications, but no disability or mortality occurred within 30 days. The mean duration of follow-up was 6.2 months. DSA examined 45 lesions (72.6%) six months postoperatively,6(13.3%) had postoperative restenoses,2 at the anterior circulation, and 4 at the posterior circulation. Of these 6,4 (66.7%) were immediate residual stenoses after stenting. Five (8.3%) ischemic events, consistent with the vascular lesions, occurred.Conclusion:Application of the Enterprise stent for AIAS patients was safe and efficacious. The technical success rate high while perioperative complications low. Residual stenosis rate was identified as a risk factor for ISR.Part two:Application of the Enterprise stent in non-acute occlusion of intracranial carotid arteriesObjective:To investigated the effect and perioperative complications of recanalization in non-acute occlusion of intracranial carotid arteries using flexible Enterprise self expanding stent.Method:During the period from June 2013 to February 2015, twelve consecutive patients with non-acute occlusion of intracranial carotid arteries received endovascular recanalization by Enterprise stenting. All patients received medication for anti-platelet aggregation therapy before and after the operation. We performed clinical evaluation by the MRS, assessed the perioperative complications, and investigated the effect of recanalization by DSA follow-up. Wilcoxon signed-rank test were performed to evaluate the improvement of MRS.Results:Of the 12 patients,10 were performed endovascular recanalization by stenting successfully. The technical success rate was 83.3%. One patient failed to implant Enterprise stent following balloon dilatation due to too small lumen diameter. One case was failed due to the guide wire failed to pass through the occlusion. For the one case of acut thrombosis, the thrombus disappeared after thrombolytic therapy by microcatheter exposure treatment. For the one case of intraoperative carotid spasm, vasospasm was relieved after antispasmodic medications. There was no perioperative mortality occurred. DSA examined 7 patients postoperatively, there was no re-occlusion occurred. Clinical follow-up were performed in 10 patients,1(10%) stroke event occurred. Wilcoxon signed-rank test showed a significant improvement of MRS during follow up period.Conclusion:The application of the Enterprise stent in non-acute occlusion of intracranial carotid arteries is technically feasible. The improvement of the prognosis of the patient depends on the success of operation and the reduction of procedure-related complications, and the long-term outcomes need to be further studied. |
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