Neurointervention.  2022 Mar;17(1):37-44. 10.5469/neuroint.2022.00017.

Usefulness of Self-Expandable Stent for Recanalization of Intracranial Atherosclerotic Disease: Preliminary Experience with Enterprise Stent

• Jung WS
• Kim SS
• Lee KY
• Suh SH

• KMID: 2526624
• DOI: http://doi.org/10.5469/neuroint.2022.00017

Abstract

Purpose
The purpose of this preliminary study is to evaluate the efficacy and safety of the Enterprise stent for intracranial atherosclerotic disease (ICAD) in patients who presented with acute stroke due to vessel steno-occlusion and in patients with symptomatic disease despite optimum medical management.
Materials and Methods
A retrospective data analysis was performed on 15 consecutive patients who were treated with Enterprise stenting for recanalization of symptomatic intracranial steno-occlusive arteries due to underlying ICAD. Their clinical and radiological data were reviewed to evaluate procedural results, periprocedural and postprocedural complications, and clinical outcome.
Results
Enterprise stents were deployed as a rescue method in 15 patients for recanalization of steno-occlusion. All patients achieved final modified thrombolysis in cerebral infarction (mTICI) score improvement (53.3% with a mTICI score from 0 to 2b or 3, 46.7% with a mTICI score from 1 to 3). Two postprocedural complications (1 symptomatic intracranial hemorrhage and 1 severe brain edema, 13.3%) occurred among 15 patients. Among 12 patients with acute ischemic stroke (AIS), 6 patients (50%) had improvement in their National Institute of Health Stroke Scale of more than 4 at discharge. Seven patients (58.3%) had a good functional outcome with 3-month modified Rankin Score (mRS)≤2, and mortality occurred (mRS=6) in 2 patients (16.7%). None of the 10 AIS and 3 transient ischemic attack patients experienced further ischemic events attributable to the treated steno-occlusion during the follow-up period (ranged from 4 to 36 months, median 12 months).
Conclusion
This retrospective study suggests that Enterprise stenting can effectively and safely achieve recanalization in symptomatic steno-occlusive intracranial arteries.

Keyword

Intracranial atherosclerosis; Intracranial stenting; Ischemic stroke

Figure

• 

  Fig. 1. An elderly patient who presented with acute left proximal MCA occlusion and NIHSS score 15. (A, B) The patient received mechanical thrombectomy initially with refractoriness due to underlying severe stenosis. (C) Enterprise stent (28 mm) was successfully deployed. (D) Fifteen minutes delayed angiography showed patent antegrade flow (mTICI score 3) in the stented segment without residual stenosis. MCA, middle cerebral artery; NIHSS, National Institutes of Health Stroke Scale; mTICI, modified thrombolysis in cerebral infarction.

• 

  Fig. 2. An elderly patient presented with recurrent transient ischemic attack refractory to antithrombotic therapy. (A) Right vertebral angiogram showed long segment severe stenosis of the right distal vertebral artery. (B) Angiogram was performed again after 3 days due to recurred ischemic symptoms during the hospitalization. Angiogram showed mTICI score of 1 with underlying stenosis. (C) Wingspan stent system failed to pass the lesion due to underlying severe stenosis. (D) Enterprise stent was successfully deployed as a rescue method with mTICI score of 3. mTICI, modified thrombolysis in cerebral infarction.

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