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iNature in-stent restenosis (ISR) is the leading cause of stroke recurrence after intracranial stenting in patients treated with standard bare metal stents (BMS)
.
Whether drug-eluting stents (DES) reduce the risk of ISR in patients with intracranial atherosclerotic stenosis (ICAS) is unclear
.
On January 4, 2022, Miao Zhongrong of Capital Medical University and Yu Wengui of the University of California, Irvine published a joint communication online in JAMA Neurology (IF=18) entitled "Comparison of Drug-Eluting Stent With Bare-Metal Stent in Patients With Symptomatic The research paper "High-grade Intracranial Atherosclerotic Stenosis: A Randomized Clinical Trial" is the world's first officially published clinical trial of intracranial drug-eluting stents, and is on the cover of this issue
.
In this study, a total of 263 participants (194 men [73.
8%]; median [IQR] age, 58 [52-65] years) were included in the analysis, and 132 were randomized to drug-stent (DES), 131 people were randomly divided into bare metal stent group (BMS)
.
The 1-year in-stent restenosis rate (ISR) was lower in the DES group than in the BMS group (10 [9.
5%] vs 32 [30.
2%]; OR, 0.
24; 95% CI, 0.
11-0.
52, p<0.
001)
.
The DES group also had a significantly lower rate of ischemic stroke recurrence from day 31 to 1 year (1 [0.
8%] vs 9 [6.
9%]; HR, 0.
1; 95% CI, 0.
01-0.
80, p=0.
03)
.
The incidence of any stroke or death at 30 days was not significantly different between the DES and BMS groups (10 [7.
6%] vs 7 [5.
3%]; OR, 1.
45; 95% CI, 0.
54-3.
94, p=0.
46
.
In conclusion, the The study found that DESs reduced the risk of ISR and ischemic stroke recurrence in patients with symptomatic high-grade ICAS compared with BMS
.
Further studies on the safety and efficacy of DESs are warranted
.
Intracranial atherosclerotic stenosis ( ICAS) is one of the most common causes of stroke worldwide, accounting for 8% to 10% of strokes in North America and 30% to 50% of strokes in Asia
.
The currently recommended strategy for stroke prevention in ICAS patients is standard medical therapy
.
In recent years, standard medical therapy has greatly reduced stroke recurrence in ICAS patients
.
However, a subset of patients remain at high risk of stroke recurrence despite medical therapy
.
For example, in stenting and active medical management to prevent intracranial stenosis In the SAMMPRIS trial, patients with border zone infarction and damaged meridians had a 1-year stroke recurrence rate of 37%
.
In the SAMMPRIS trial and the Vitesse Ischemic Stroke Treatment Intracranial Stent Study (VISSIT) trial, cranial Stents, as a potential treatment for ICAS with impaired blood flow, are less effective than medical therapy, mainly due to the high complication rates associated with stents
.
Recently, the Registry Study on Stent Implantation in Symptomatic Intracranial Arterial Stenosis and the Wingspan Stent System Postmarketing Surveillance (WEAVE) trial conducted in China showed a 2.
6% to 4.
3% incidence of operative complications, suggesting that Intracranial stenting may be safe in carefully selected patients with ICAS
.
Another major obstacle to intracranial stenting is in-stent restenosis (ISR), a common cause of unprogrammed ischemic events following intracranial stenting
.
In-stent restenosis occurs in 15% to 33% of patients who receive the current standard of self-expanding or balloon bare-metal stents (BMS) within one year
.
Drug-eluting stents (DESs) reduce the ISR after stent placement by inhibiting the proliferation and migration of endothelial cells and smooth muscle cells
.
DES has revolutionized the treatment of coronary artery disease by substantially reducing ischemia-reperfusion rates and associated ischemic events
.
Currently, DES is recommended as the first-line device over BMS in percutaneous coronary intervention
.
It has been reported that the use of DES in ICAS is safe and feasible
.
A recent meta-analysis of 13 studies showed an ISR rate of 4.
1% in 364 ICAS lesions treated with DES
.
However, previous studies were mostly retrospective uncontrolled case series with relatively small sample sizes
.
The purpose of this randomized clinical trial was to investigate whether DESs reduce the risk of ISR and stroke recurrence in hospitalized patients with symptomatic high-grade ICAS
.
CONSORT Diagram (picture from JAMA Neurology) In this study, the primary endpoint is the incidence of in-stent restenosis within one year after stent implantation, and the secondary endpoints are the recurrence rate of ischemic and hemorrhagic stroke, the incidence of death, etc.
.
In the study, a total of 263 participants (194 men [73.
8%]; median [IQR] age, 58 [52-65] years) were included in the analysis, 132 were randomized to drug-stent (DES), 131 Randomly divided into bare metal stent group (BMS)
.
The 1-year in-stent restenosis rate (ISR) was lower in the DES group than in the BMS group (10 [9.
5%] vs 32 [30.
2%]; OR, 0.
24; 95% CI, 0.
11-0.
52, p<0.
001)
.
The DES group also had a significantly lower rate of ischemic stroke recurrence from day 31 to 1 year (1 [0.
8%] vs 9 [6.
9%]; HR, 0.
1; 95% CI, 0.
01-0.
80, p=0.
03)
.
The incidence of any stroke or death within 30 days was not significantly different between the DES and BMS groups (10 [7.
6%] vs 7 [5.
3%]; OR, 1.
45; 95% CI, 0.
54-3.
94, p=0.
46)
.
In conclusion, the results of this study suggest that in patients with highly symptomatic ICAS, DES is superior to BMS in reducing the incidence of ISR and the risk of recurrent ischemic stroke in the target vessel region
.
Further research confirmed the safety and efficacy of DESs in stroke prevention in ICAS patients, and also reflected the future development potential and hope of intracranial drug-eluting stents
.
Reference message: https://jamanetwork.
com/journals/jamaneurology/article-abstract/2787238
.
Whether drug-eluting stents (DES) reduce the risk of ISR in patients with intracranial atherosclerotic stenosis (ICAS) is unclear
.
On January 4, 2022, Miao Zhongrong of Capital Medical University and Yu Wengui of the University of California, Irvine published a joint communication online in JAMA Neurology (IF=18) entitled "Comparison of Drug-Eluting Stent With Bare-Metal Stent in Patients With Symptomatic The research paper "High-grade Intracranial Atherosclerotic Stenosis: A Randomized Clinical Trial" is the world's first officially published clinical trial of intracranial drug-eluting stents, and is on the cover of this issue
.
In this study, a total of 263 participants (194 men [73.
8%]; median [IQR] age, 58 [52-65] years) were included in the analysis, and 132 were randomized to drug-stent (DES), 131 people were randomly divided into bare metal stent group (BMS)
.
The 1-year in-stent restenosis rate (ISR) was lower in the DES group than in the BMS group (10 [9.
5%] vs 32 [30.
2%]; OR, 0.
24; 95% CI, 0.
11-0.
52, p<0.
001)
.
The DES group also had a significantly lower rate of ischemic stroke recurrence from day 31 to 1 year (1 [0.
8%] vs 9 [6.
9%]; HR, 0.
1; 95% CI, 0.
01-0.
80, p=0.
03)
.
The incidence of any stroke or death at 30 days was not significantly different between the DES and BMS groups (10 [7.
6%] vs 7 [5.
3%]; OR, 1.
45; 95% CI, 0.
54-3.
94, p=0.
46
.
In conclusion, the The study found that DESs reduced the risk of ISR and ischemic stroke recurrence in patients with symptomatic high-grade ICAS compared with BMS
.
Further studies on the safety and efficacy of DESs are warranted
.
Intracranial atherosclerotic stenosis ( ICAS) is one of the most common causes of stroke worldwide, accounting for 8% to 10% of strokes in North America and 30% to 50% of strokes in Asia
.
The currently recommended strategy for stroke prevention in ICAS patients is standard medical therapy
.
In recent years, standard medical therapy has greatly reduced stroke recurrence in ICAS patients
.
However, a subset of patients remain at high risk of stroke recurrence despite medical therapy
.
For example, in stenting and active medical management to prevent intracranial stenosis In the SAMMPRIS trial, patients with border zone infarction and damaged meridians had a 1-year stroke recurrence rate of 37%
.
In the SAMMPRIS trial and the Vitesse Ischemic Stroke Treatment Intracranial Stent Study (VISSIT) trial, cranial Stents, as a potential treatment for ICAS with impaired blood flow, are less effective than medical therapy, mainly due to the high complication rates associated with stents
.
Recently, the Registry Study on Stent Implantation in Symptomatic Intracranial Arterial Stenosis and the Wingspan Stent System Postmarketing Surveillance (WEAVE) trial conducted in China showed a 2.
6% to 4.
3% incidence of operative complications, suggesting that Intracranial stenting may be safe in carefully selected patients with ICAS
.
Another major obstacle to intracranial stenting is in-stent restenosis (ISR), a common cause of unprogrammed ischemic events following intracranial stenting
.
In-stent restenosis occurs in 15% to 33% of patients who receive the current standard of self-expanding or balloon bare-metal stents (BMS) within one year
.
Drug-eluting stents (DESs) reduce the ISR after stent placement by inhibiting the proliferation and migration of endothelial cells and smooth muscle cells
.
DES has revolutionized the treatment of coronary artery disease by substantially reducing ischemia-reperfusion rates and associated ischemic events
.
Currently, DES is recommended as the first-line device over BMS in percutaneous coronary intervention
.
It has been reported that the use of DES in ICAS is safe and feasible
.
A recent meta-analysis of 13 studies showed an ISR rate of 4.
1% in 364 ICAS lesions treated with DES
.
However, previous studies were mostly retrospective uncontrolled case series with relatively small sample sizes
.
The purpose of this randomized clinical trial was to investigate whether DESs reduce the risk of ISR and stroke recurrence in hospitalized patients with symptomatic high-grade ICAS
.
CONSORT Diagram (picture from JAMA Neurology) In this study, the primary endpoint is the incidence of in-stent restenosis within one year after stent implantation, and the secondary endpoints are the recurrence rate of ischemic and hemorrhagic stroke, the incidence of death, etc.
.
In the study, a total of 263 participants (194 men [73.
8%]; median [IQR] age, 58 [52-65] years) were included in the analysis, 132 were randomized to drug-stent (DES), 131 Randomly divided into bare metal stent group (BMS)
.
The 1-year in-stent restenosis rate (ISR) was lower in the DES group than in the BMS group (10 [9.
5%] vs 32 [30.
2%]; OR, 0.
24; 95% CI, 0.
11-0.
52, p<0.
001)
.
The DES group also had a significantly lower rate of ischemic stroke recurrence from day 31 to 1 year (1 [0.
8%] vs 9 [6.
9%]; HR, 0.
1; 95% CI, 0.
01-0.
80, p=0.
03)
.
The incidence of any stroke or death within 30 days was not significantly different between the DES and BMS groups (10 [7.
6%] vs 7 [5.
3%]; OR, 1.
45; 95% CI, 0.
54-3.
94, p=0.
46)
.
In conclusion, the results of this study suggest that in patients with highly symptomatic ICAS, DES is superior to BMS in reducing the incidence of ISR and the risk of recurrent ischemic stroke in the target vessel region
.
Further research confirmed the safety and efficacy of DESs in stroke prevention in ICAS patients, and also reflected the future development potential and hope of intracranial drug-eluting stents
.
Reference message: https://jamanetwork.
com/journals/jamaneurology/article-abstract/2787238
