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Adnan I. Qureshi - One of the best experts on this subject based on the ideXlab platform.
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abstract wp182 re analysis of Stenting versus aggressive medical therapy for Intracranial arterial stenosis sammpris trial using the new food and drug administration fda on label criteria
Stroke, 2020Co-Authors: Sargun S Walia, Farhan Siddiq, Wei Huang, Iryna Lobanova, Brandi R French, Camilo R Gomez, Adnan I. QureshiAbstract:Background: Due to higher rates of 1-month stroke and death with Wingspan Intracranial Stent placement observed in SAMMPRIS, FDA announced a more limited indication for Wingspan Stent. We compared ...
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multicenter prospective trial of Stent placement in patients with symptomatic high grade Intracranial stenosis
American Journal of Neuroradiology, 2016Co-Authors: D Wang, Adnan I. Qureshi, Liqun Jiao, Zhenwei Zhao, Shengping Huang, T Li, W Wu, W He, X Ji, F LingAbstract:BACKGROUND AND PURPOSE: On the basis of the high 1-month stroke and/or death (14.7%) rates associated with Stent placement in the Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial, modifications in patient selection and procedural aspects for Intracranial Stent placement have been recommended. We performed a multicenter prospective single-arm trial to determine whether such modifications would result in lower rates of periprocedural stroke and/or death. MATERIALS AND METHODS: The study enrolled patients with recent transient ischemic attack or ischemic stroke (excluding perforator ischemic events) related to high-grade (70%–99% in severity) stenosis of a major Intracranial artery. Patients were treated by using angioplasty and self-expanding Stents 3 weeks after the index ischemic event at 1 of the 10 high-volume centers in China. An independent neurologist ascertained the occurrence of any stroke and/or death within 1 month after the procedure. RESULTS: A total of 100 consecutive patients were recruited. The target lesions were located in the middle cerebral artery (M1) ( n = 38, 38%), Intracranial internal carotid artery ( n = 17, 17%), intradural vertebral artery ( n = 18, 18%), and basilar artery ( n = 27, 27%). The technical success rate of Stent deployment with residual stenosis of CONCLUSIONS: The results of this prospective multicenter study demonstrated that modifications in patient selection and procedural aspects can substantially reduce the 1-month stroke and/or death rate following Intracranial Stent placement.
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Impact of SAMMPRIS Trial on Intracranial Stent Placement: A State Wide Study (P1.149)
Neurology, 2014Co-Authors: Farhan Siddiq, Saqib A. Chaudhry, Malik M Adil, Adnan I. QureshiAbstract:Objective: To test whether the frequency of Intracranial Stent placement has decreased in most endovascular neurosurgical centers after the publication of SAMMPRIS. Background: Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial was published in 2011 which reported high rates of post-operative stroke and death in Intracranial Stent treated group and off setting the pre assumed benefit of the procedure for prevention of recurrent ischemic stroke in this patient population Methods: We used Minnesota Hospital Association (MHA) data from 2008-2012 to identify patient who were treated with Intracranial Stent placement using ICD-9 codes. 2011 year was excluded from the analysis to account for transitions period during the year of SAMMPRIS publication. Prior to 2011 years were included in “pre SAMMPRIS group” and 2012 was included in “post SAMMPRIS group”. Patients demographic, in-hospital complications and discharge destinations were compared between the two groups. We also assessed the frequency of procedures per year. Results: The frequency of Intracranial Stent placement decreased by approximately half in the post SAMMPRIS period. Three years prior to 2011, approximately 30 procedures were documented each year whereas in 2012 only 17 procedures were reported in the state (p < 0.0001). Age, gender, medical comorbidity, in-hospital complications, in-hospital mortality and discharge destination did not differ between the pre and post SAMMPRIS patient population (see Table). Conclusion: After the publication of SAMMPRIS results in 2011, the frequency of Intracranial Stent placement has decreased significantly. The patients who are currently offered this treatment do not appear to be different from population prior to SAMMPRIS publication. Disclosure: Dr. Siddiq has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Nickles has nothing to disclose. Dr. Qureshi has nothing to disclose.
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Comparison of Intracranial Stent Placement and Best Medical Treatment Alone for Treatment of Symptomatic Intracranial Stenosis (P1.148)
Neurology, 2014Co-Authors: Vikram Jadhav, Mushtaq H Qureshi, Adnan I. QureshiAbstract:OBJECTIVE: To compare the short and long term rates of transient ischemic attack (TIA)/ ischemic stroke and mortality between Intracranial Stent placement and medical therapy alone for treatment of symptomatic Intracranial arterial stenosis. DESIGN/METHODS: We identified all prospective and retrospective studies comparing Intracranial Stent placement and medical management using a search on PubMed and Cochrane libraries, stroke trials database, proceedings of neurology and neurosurgery related conferences, and supplemented by a review of bibliographies of selected publications. The incidences of adverse effects, namely TIA/stroke and/or death at 30 days post treatment and TIA/stroke, myocardial infarction and/or death at 1 year post treatment were ascertained from all studies. For the meta-analysis, Forest plots and calculation of odds ratios [OR] with 95% confidence intervals [CI] using both fixed and random models were performed. The presence of publication bias was interrogated by funnel plot of Standard Error by log odds ratio. RESULTS: Three prospective studies including two randomized clinical trials and one retrospective study were identified and included in the meta-analysis. There were a total of 46/347 (13.2%) stroke-and/or-deaths reported in the Stent treatment group compared with 16/351 (4.5%) TIA/stroke-and/or-deaths in the medical therapy alone group at 30 days (OR, 2.97; P
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Abstract W P105: Comparison of Intracranial Stent Placement and Best Medical Treatment Alone for Treatment of Symptomatic Intracranial Stenosis
Stroke, 2014Co-Authors: Vikram Jadhav, Mushtaq H Qureshi, Nidaullah Mian, Adnan I. QureshiAbstract:Objective: To compare the short and long term rates of transient ischemic attack (TIA)/ ischemic stroke and mortality between Intracranial Stent placement and medical therapy alone for treatment of symptomatic Intracranial arterial stenosis. Methods: We identified all prospective and retrospective studies comparing Intracranial Stent placement and medical management using a search on PubMed and Cochrane libraries, stroke trials database, proceedings of neurology and neurosurgery related conferences, and supplemented by a review of bibliographies of selected publications. The incidences of adverse effects, namely TIA/stroke and/or death at 30 days post treatment and TIA/stroke, myocardial infarction and/or death at 1 year post treatment were ascertained from all studies. For the meta-analysis, Forest plots and calculation of odds ratios [OR] with 95% confidence intervals [CI] using both fixed and random models were performed. The presence of publication bias was interrogated by funnel plot of Standard Error by log odds ratio. Results: Three prospective studies including two randomized clinical trials and one retrospective study were identified and included in the meta-analysis. There were a total of 46/347 (13.2%) stroke-and/or-deaths reported in the Stent treatment group compared with 16/351 (4.5%) TIA/stroke-and/or-deaths in the medical therapy alone group at 30 days (OR, 2.97; P Conclusions: Despite the higher risk of 1 month TIA/stroke-and/or-deaths, patients undergoing Intracranial Stent placement have similar rates of TIA/stroke-and/or-deaths at 1 year compared with medical treatment alone.
Farhan Siddiq - One of the best experts on this subject based on the ideXlab platform.
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abstract wp182 re analysis of Stenting versus aggressive medical therapy for Intracranial arterial stenosis sammpris trial using the new food and drug administration fda on label criteria
Stroke, 2020Co-Authors: Sargun S Walia, Farhan Siddiq, Wei Huang, Iryna Lobanova, Brandi R French, Camilo R Gomez, Adnan I. QureshiAbstract:Background: Due to higher rates of 1-month stroke and death with Wingspan Intracranial Stent placement observed in SAMMPRIS, FDA announced a more limited indication for Wingspan Stent. We compared ...
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Impact of SAMMPRIS Trial on Intracranial Stent Placement: A State Wide Study (P1.149)
Neurology, 2014Co-Authors: Farhan Siddiq, Saqib A. Chaudhry, Malik M Adil, Adnan I. QureshiAbstract:Objective: To test whether the frequency of Intracranial Stent placement has decreased in most endovascular neurosurgical centers after the publication of SAMMPRIS. Background: Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial was published in 2011 which reported high rates of post-operative stroke and death in Intracranial Stent treated group and off setting the pre assumed benefit of the procedure for prevention of recurrent ischemic stroke in this patient population Methods: We used Minnesota Hospital Association (MHA) data from 2008-2012 to identify patient who were treated with Intracranial Stent placement using ICD-9 codes. 2011 year was excluded from the analysis to account for transitions period during the year of SAMMPRIS publication. Prior to 2011 years were included in “pre SAMMPRIS group” and 2012 was included in “post SAMMPRIS group”. Patients demographic, in-hospital complications and discharge destinations were compared between the two groups. We also assessed the frequency of procedures per year. Results: The frequency of Intracranial Stent placement decreased by approximately half in the post SAMMPRIS period. Three years prior to 2011, approximately 30 procedures were documented each year whereas in 2012 only 17 procedures were reported in the state (p < 0.0001). Age, gender, medical comorbidity, in-hospital complications, in-hospital mortality and discharge destination did not differ between the pre and post SAMMPRIS patient population (see Table). Conclusion: After the publication of SAMMPRIS results in 2011, the frequency of Intracranial Stent placement has decreased significantly. The patients who are currently offered this treatment do not appear to be different from population prior to SAMMPRIS publication. Disclosure: Dr. Siddiq has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Nickles has nothing to disclose. Dr. Qureshi has nothing to disclose.
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Intracranial Stent Placement for Symptomatic Intracranial Stenosis as Part of a Clinical Trial Versus Outside a Clinical Trial
Stroke, 2013Co-Authors: Farhan Siddiq, Malik M Adil, Kiersten Norby, Adnan I. QureshiAbstract:Background and Purpose—A high rate of postprocedure complications in the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial has raised concerns whether such results are representative of Intracranial Stent placement in actual routine practice. Methods—Using the Nationwide Inpatient Sample from 2008 to 2010, patients with cerebral ischemic events treated with Intracranial Stent as part of a clinical trial or outside the trial were identified. The composite end point (postoperative stroke, cardiac complications, and mortality) was reported. Results—Of the 3447 patients who underwent Intracranial Stent placement, 223 patients (6.5%) were enrolled in a clinical trial. The rate of composite end point was higher in patients treated outside clinical trials compared with those treated within clinical trials (14.2% versus 4.5%; P=0.1). The proportion of patients discharged to home was higher in those treated in clinical trials (76.8% versus 49.6%; P=0.001). Conclusions—I...
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Abstract 58: Rates Of Postoperative Stroke, Cardiac Complication And Mortality In Patients Undergoing Intracranial Stent Placement As Part Of A Clinical Trial Versus Those Treated Outside A Clinical Trial
Stroke, 2013Co-Authors: Farhan Siddiq, Malik M Adil, Adnan I. QureshiAbstract:Background: The pre-maturely discontinued Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial demonstrated lack of benefit of Intracranial Stent placement due to high rates of immediate post procedure complications. The rates of complications were higher than those reported previously raising the question whether such results were representative of Intracranial Stent placement in actual routine practice. Objective: To ascertain and compare the rate of outcomes between patients who underwent Intracranial Stent placement within and outside clinical trials. Materials/Methods: Using the Nationwide Inpatient Sample (NIS) from 2008 to 2010, patients with cerebral ischemic events who underwent Intracranial Stent placement were identified using ICD-9 diagnosis and procedure codes. Patients were divided into those who received Intracranial Stent placement as part of the clinical trial and those who were treated outside any trial. The postoperative mortality, stroke and cardiac complications were primary endpoints. Results: A total of 3447 patient underwent Intracranial Stent placement, 223 patients (6.5%) were enrolled in a clinical trial. Patients who received Intracranial Stent placement as part of the clinical trial were significantly younger (65±10 versus 68±13 years, p=0.008). Both groups did not differ in terms of gender, race and ethnicity and medical co-morbidities. Mean length of stay was longer in patients treated outside a clinical trial (9.1±11 versus 5.1±4, p Conclusions: Patients who undergo Intracranial Stent placement outside a clinical trial have higher rates of postoperative stroke, cardiac complication and mortality. Such results support those of the SAMMPRIS trial and the need for restricting these procedures to selected patients and specialized centers with high experience.
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Abstract 125: A Randomized Trial Comparing Primary Angioplasty versus Stent Placement for Symptomatic Intracranial Stenosis
Stroke, 2012Co-Authors: M. Fareed K. Suri, Shahram Majidi, Saqib A. Chaudhry, Gustavo J. Rodriguez, Farhan Siddiq, Adnan I. QureshiAbstract:Introduction: The Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) was prematurely terminated due to excessively high rate of stroke and death in patients randomized to Intracranial Stent placement. Equivalent results with primary angioplasty in several uncontrolled studies will continue to raise the question that a policy of mandatory Stent placement may have led to a higher peri-procedural stroke and death without a clear evidence of incremental benefit. Methods: The primary aim of the study is to compare the clinical and angiographic efficacy of primary angioplasty and angioplasty followed by Stent placement in preventing restenosis, stroke, requirement for second treatment, and death in patients with symptomatic Intracranial stenosis. The study prospectively evaluated acute,1-month, 6 month, and 1-year efficacy and safety of the two existing neurointerventional techniques for treatment of moderate Intracranial stenosis (stenosis ≥50%) with documented failure of medical treatment or severe stenosis (≥70%) with or without failure of medical treatment. Results: A total of 18 patients were recruited in the study; mean age [±SD] was 64.7±15.1 years, 12 were men. Of these 18, 10 were randomized to primary angioplasty and 8 were randomized to angioplasty followed by self expanding Stent. The technical success rates of Intracranial angioplasty and Stent placements defined as ability to achieve Conclusions: The trial suggests that a randomized trial comparing primary angioplasty to angioplasty followed by Stent placement is feasible. The immediate procedural outcomes with primary angioplasty are comparable to Stent placement and warrant further studies.
Ajay K Wakhloo - One of the best experts on this subject based on the ideXlab platform.
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E-019 Initial post market experience with the pulserider Intracranial Stent
Electronic Poster Abstracts, 2018Co-Authors: K De Macedo Rodrigues, Ajay K Wakhloo, Peter Kan, Anna Luisa Kühn, David E Rex, Francesco Massari, Ajit S. PuriAbstract:Purpose To show a two-centers initial post market experience with the use of a new Intracranial Stent specially designed for wide neck bifurcation aneurysm. Materials and methods We retrospectively reviewed 6 consecutive cases of elective endovascular treatment of bifurcation aneurysms with the use of the PulseRider nitinol implant (Pulsar Vascular, Los Gatos, California) in addition to bare platinum embolization coils. A total of 6 patients (5 females) with 6 aneurysms (4 basilar, 2 anterior communicating artery) with age ranging from 51–67 years old were included. Dual anti-platelet therapy was started 5 days prior to the procedure. Three ‘Y’ shape and 3 ‘T’ shape devices were utilized. Angiogram post device placement and coil placement were analyzed. A 6 month post procedure diagnostic cerebral angiogram was available for 2 patients. Results Implant placement and subsequent aneurysm sac coil embolization successfully performed for all patients. Two patients had the resheatable implant retrieved for shape exchange. A 28% mean packing density was achieved. No periprocedural or immediate post procedural complications encountered. Two patients had a 6 month follow-up angiogram showing complete aneurysm occlusion. Conclusion/summary Technical feasibility of the use of the PulseRider Intracranial Stent demonstrated in all 6 cases for endovascular embolization of wide neck bifurcation aneurysms. Limitations of this case series include small sample size, only 2 patients with a follow-up angiogram available and lack of long term clinical follow-up. Disclosures K. de Macedo Rodrigues: None. P. Kan: 2; C; Stryker, Medtronic. A. Kuhn: None. D. Rex: None. F. Massari: None. A. Wakhloo: 1; C; Philips Healthcare. 2; C; Stryker Neurovascular. 3; C; Harvard Postgraduate Course, Miami Cardiovascular Institute. 4; C; InNeuroCo. A. Puri: 1; C; Stryker Neurovascular, Covidien. 2; C; Codman Neurovascular, Covidien. 4; C; InNeuroCo.
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effect of a balloon expandable Intracranial Stent vs medical therapy on risk of stroke in patients with symptomatic Intracranial stenosis the vissit randomized clinical trial
JAMA, 2015Co-Authors: Osama O. Zaidat, Britton Keith Woodward, Howard S Kirshner, Brian-fred Fitzsimmons, Monika Killeroberpfalzer, Ajay K Wakhloo, Rishi Gupta, Zhigang Wang, Thomas J Megerian, James LeskoAbstract:Importance Intracranial stenosis is one of the most common etiologies of stroke. To our knowledge, no randomized clinical trials have compared balloon-expandable Stent treatment with medical therapy in symptomatic Intracranial arterial stenosis. Objective To evaluate the efficacy and safety of the balloon-expandable Stent plus medical therapy vs medical therapy alone in patients with symptomatic Intracranial stenosis (≥70%). Design, Setting, and Patients VISSIT (the Vitesse Intracranial Stent Study for Ischemic Stroke Therapy) trial is an international, multicenter, 1:1 randomized, parallel group trial that enrolled patients from 27 sites (January 2009-June 2012) with last follow-up in May 2013. Interventions Patients (N = 112) were randomized to receive balloon-expandable Stent plus medical therapy (Stent group; n = 59) or medical therapy alone (medical group; n = 53). Main Outcomes and Measures Primary outcome measure: a composite of stroke in the same territory within 12 months of randomization or hard transient ischemic attack (TIA) in the same territory day 2 through month 12 postrandomization. A hard TIA was defined as a transient episode of neurological dysfunction caused by focal brain or retinal ischemia lasting at least 10 minutes but resolving within 24 hours. Primary safety measure: a composite of any stroke, death, or Intracranial hemorrhage within 30 days of randomization and any hard TIA between days 2 and 30 of randomization. Disability was measured with the modified Rankin Scale and general health status with the EuroQol-5D, both through month 12. Results Enrollment was halted by the sponsor after negative results from another trial prompted an early analysis of outcomes, which suggested futility after 112 patients of a planned sample size of 250 were enrolled. The 30-day primary safety end point occurred in more patients in the Stent group (14/58; 24.1% [95% CI, 13.9%-37.2%]) vs the medical group (5/53; 9.4% [95% CI, 3.1%-20.7%]) ( P = .05). Intracranial hemorrhage within 30 days occurred in more patients in the Stent group (5/58; 8.6% [95% CI, 2.9%-19.0%]) vs none in the medical group (95% CI, 0%-5.5%) ( P = .06). The 1-year primary outcome of stroke or hard TIA occurred in more patients in the Stent group (21/58; 36.2% [95% CI, 24.0-49.9]) vs the medical group (8/53; 15.1% [95% CI, 6.7-27.6]) ( P = .02). Worsening of baseline disability score (modified Rankin Scale) occurred in more patients in the Stent group (14/58; 24.1% [95% CI, 13.9%-37.2%]) vs the medical group (6/53; 11.3% [95% CI, 4.3%-23.0%]) ( P = .09).The EuroQol-5D showed no difference in any of the 5 dimensions between groups at 12-month follow-up. Conclusions and Relevance Among patients with symptomatic Intracranial arterial stenosis, the use of a balloon-expandable Stent compared with medical therapy resulted in an increased 12-month risk of added stroke or TIA in the same territory, and increased 30-day risk of any stroke or TIA. These findings do not support the use of a balloon-expandable Stent for patients with symptomatic Intracranial arterial stenosis. Trial Registration clinicaltrials.gov Identifier:NCT00816166.
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effect of a balloon expandable Intracranial Stent vs medical therapy on risk of stroke in patients with symptomatic Intracranial stenosis the vissit randomized clinical trial
JAMA, 2015Co-Authors: Osama O. Zaidat, Britton Keith Woodward, Howard S Kirshner, Brian-fred Fitzsimmons, Monika Killeroberpfalzer, Ajay K Wakhloo, Rishi Gupta, Zhigang Wang, Thomas J Megerian, James LeskoAbstract:Importance Intracranial stenosis is one of the most common etiologies of stroke. To our knowledge, no randomized clinical trials have compared balloon-expandable Stent treatment with medical therapy in symptomatic Intracranial arterial stenosis. Objective To evaluate the efficacy and safety of the balloon-expandable Stent plus medical therapy vs medical therapy alone in patients with symptomatic Intracranial stenosis (≥70%). Design, Setting, and Patients VISSIT (the Vitesse Intracranial Stent Study for Ischemic Stroke Therapy) trial is an international, multicenter, 1:1 randomized, parallel group trial that enrolled patients from 27 sites (January 2009-June 2012) with last follow-up in May 2013. Interventions Patients (N = 112) were randomized to receive balloon-expandable Stent plus medical therapy (Stent group; n = 59) or medical therapy alone (medical group; n = 53). Main Outcomes and Measures Primary outcome measure: a composite of stroke in the same territory within 12 months of randomization or hard transient ischemic attack (TIA) in the same territory day 2 through month 12 postrandomization. A hard TIA was defined as a transient episode of neurological dysfunction caused by focal brain or retinal ischemia lasting at least 10 minutes but resolving within 24 hours. Primary safety measure: a composite of any stroke, death, or Intracranial hemorrhage within 30 days of randomization and any hard TIA between days 2 and 30 of randomization. Disability was measured with the modified Rankin Scale and general health status with the EuroQol-5D, both through month 12. Results Enrollment was halted by the sponsor after negative results from another trial prompted an early analysis of outcomes, which suggested futility after 112 patients of a planned sample size of 250 were enrolled. The 30-day primary safety end point occurred in more patients in the Stent group (14/58; 24.1% [95% CI, 13.9%-37.2%]) vs the medical group (5/53; 9.4% [95% CI, 3.1%-20.7%]) ( P = .05). Intracranial hemorrhage within 30 days occurred in more patients in the Stent group (5/58; 8.6% [95% CI, 2.9%-19.0%]) vs none in the medical group (95% CI, 0%-5.5%) ( P = .06). The 1-year primary outcome of stroke or hard TIA occurred in more patients in the Stent group (21/58; 36.2% [95% CI, 24.0-49.9]) vs the medical group (8/53; 15.1% [95% CI, 6.7-27.6]) ( P = .02). Worsening of baseline disability score (modified Rankin Scale) occurred in more patients in the Stent group (14/58; 24.1% [95% CI, 13.9%-37.2%]) vs the medical group (6/53; 11.3% [95% CI, 4.3%-23.0%]) ( P = .09).The EuroQol-5D showed no difference in any of the 5 dimensions between groups at 12-month follow-up. Conclusions and Relevance Among patients with symptomatic Intracranial arterial stenosis, the use of a balloon-expandable Stent compared with medical therapy resulted in an increased 12-month risk of added stroke or TIA in the same territory, and increased 30-day risk of any stroke or TIA. These findings do not support the use of a balloon-expandable Stent for patients with symptomatic Intracranial arterial stenosis. Trial Registration clinicaltrials.gov Identifier:NCT00816166.
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design of the vitesse Intracranial Stent study for ischemic therapy vissit trial in symptomatic Intracranial stenosis
Journal of Stroke & Cerebrovascular Diseases, 2013Co-Authors: Osama O. Zaidat, Alicia C Castonguay, Britton Keith Woodward, Howard S Kirshner, Brian-fred Fitzsimmons, Monika Killeroberpfalzer, Ajay K Wakhloo, Rishi Gupta, Zhigang Wang, Misha EliasziwAbstract:Background Patients with high-grade symptomatic Intracranial stenosis (≥70%) have an increased risk of recurrent stroke despite medical treatment with antiplatelet or anticoagulant therapy. Intracranial Stenting has been proposed as a viable treatment option for this high-risk patient population; however, evaluation of this therapy in randomized multicenter trials is needed. In this article, we present the design and methods of the Vitesse Intracranial Stent Study for Ischemic Therapy (VISSIT) trial for symptomatic Intracranial stenosis. Methods The VISSIT trial is a randomized control study designed to evaluate the safety, probable benefit, and effectiveness of the PHAROS Vitesse neurovascular balloon-expandable Stent system plus medical therapy versus medical therapy alone in patients with cerebral or retinal ischemia due to neurovascular stenosis (≥70%) for preventing the primary composite end point: stroke in the same territory (distal to the target lesion) as the presenting event within 12 months of randomization or hard transient ischemic attack in the same territory (distal to the target lesion) as the presenting event from day 2 through month 12 postrandomization. Results Enrollment began in February 2009 and was halted in January 2012 with 112 subjects enrolled into the study. Clinical follow-up will continue for the planned period of 12 months postrandomization. Conclusions The VISSIT trial may provide valuable insight into the use of balloon-expandable Intracranial Stent as a treatment option for high-risk patients. Lessons learned from this trial may better guide future clinical trial design on best patient selection, Stenting techniques, and periprocedural management.
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The effect of Intracranial Stent implantation on the curvature of the cerebrovasculature.
AJNR. American journal of neuroradiology, 2012Co-Authors: Robert M. King, Ajay K Wakhloo, Juyu Chueh, I. M. J. Van Der Bom, Christine F. Silva, S Carniato, Gabriela Spilberg, Matthew J. GounisAbstract:BACKGROUND AND PURPOSE: Recently, the use of Stents to assist in the coiling and repair of wide-neck aneurysms has been shown to be highly effective; however, the effect of these Stents on the RC of the parent vessel has not been quantified. The purpose of this study was to quantify the effect of Intracranial Stenting on the RC of the implanted artery using 3D datasets. MATERIALS AND METHODS: Twenty-four patients receiving FDA-approved neurovascular Stents to support coil embolization of brain aneurysms were chosen for this study. The Stents were located in the ICA, ACA, or MCA. We analyzed C-arm rotational angiography and contrast-enhanced cone beam CT datasets before and after Stent implantation, respectively, to ascertain changes in vessel curvature. The images were reconstructed, and the vessel centerline was extracted. From the centerline, the RC was calculated. RESULTS: The average implanted Stent length was 25.4 ± 5.8 mm, with a pre-implantation RC of 7.1 ± 2.1 mm and a postimplantation RC of 10.7 ± 3.5 mm. This resulted in a 3.6 ± 2.7 mm change in the RC due to implantation ( P < .0001), more than a 50% increase from the pre-implantation value. There was no difference in the change of RC for the different locations studied. The change in RC was not impacted by the extent of coil packing within the aneurysm. CONCLUSIONS: The implantation of neurovascular Stents can be shown to have a large impact on the RC of the vessel. This will lead to a change in the local hemodynamics and flow pattern within the aneurysm. ACA : anterior cerebral artery CBCT : cone-beam CT CFD : computational fluid dynamics 3DRA : 3D rotational angiography NiTi : nitinol RC : radius of curvature
M. Moreu - One of the best experts on this subject based on the ideXlab platform.
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Use of Intracranial Stent as rescue therapy after mechanical thrombectomy failure—9-year experience in a comprehensive stroke centre
Neuroradiology, 2020Co-Authors: C. Pérez-garcía, C. Gómez-escalonilla, S. Rosati, L. López-ibor, J. A. Egido, P. Simal, M. MoreuAbstract:Purpose There is no established rescue treatment in patients with mechanical thrombectomy (MT) failure. Our aim is to analyse whether the use of an Intracranial Stent improves prognosis in these patients. Methods Retrospective analysis of a prospective cohort of patients with ischemic stroke due to middle cerebral artery occlusion (MCA) or distal Intracranial carotid artery (ICA) occlusion, from September 2009 to April 2019 in our comprehensive stroke care centre. Patients with MT failure were identified and dichotomized into two groups according to whether or not an Intracranial Stent was implanted. We analysed clinical outcomes in both groups. Results There was MT failure in 60 patients (14%) of the 433 with large vessel occlusion in distal ICA and proximal MCA. A Stent was placed in 20 of them (33.3%). Compared to patients without rescue Stenting, they showed better rates of independence at 3 months (mRS ≤ 2) 45% vs 2.5% ( p
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Use of Intracranial Stent as rescue therapy after mechanical thrombectomy failure-9-year experience in a comprehensive stroke centre.
Neuroradiology, 2020Co-Authors: C. Pérez-garcía, C. Gómez-escalonilla, S. Rosati, L. López-ibor, J. A. Egido, P. Simal, M. MoreuAbstract:There is no established rescue treatment in patients with mechanical thrombectomy (MT) failure. Our aim is to analyse whether the use of an Intracranial Stent improves prognosis in these patients. Retrospective analysis of a prospective cohort of patients with ischemic stroke due to middle cerebral artery occlusion (MCA) or distal Intracranial carotid artery (ICA) occlusion, from September 2009 to April 2019 in our comprehensive stroke care centre. Patients with MT failure were identified and dichotomized into two groups according to whether or not an Intracranial Stent was implanted. We analysed clinical outcomes in both groups. There was MT failure in 60 patients (14%) of the 433 with large vessel occlusion in distal ICA and proximal MCA. A Stent was placed in 20 of them (33.3%). Compared to patients without rescue Stenting, they showed better rates of independence at 3 months (mRS ≤ 2) 45% vs 2.5% (p
Malik M Adil - One of the best experts on this subject based on the ideXlab platform.
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Impact of SAMMPRIS Trial on Intracranial Stent Placement: A State Wide Study (P1.149)
Neurology, 2014Co-Authors: Farhan Siddiq, Saqib A. Chaudhry, Malik M Adil, Adnan I. QureshiAbstract:Objective: To test whether the frequency of Intracranial Stent placement has decreased in most endovascular neurosurgical centers after the publication of SAMMPRIS. Background: Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial was published in 2011 which reported high rates of post-operative stroke and death in Intracranial Stent treated group and off setting the pre assumed benefit of the procedure for prevention of recurrent ischemic stroke in this patient population Methods: We used Minnesota Hospital Association (MHA) data from 2008-2012 to identify patient who were treated with Intracranial Stent placement using ICD-9 codes. 2011 year was excluded from the analysis to account for transitions period during the year of SAMMPRIS publication. Prior to 2011 years were included in “pre SAMMPRIS group” and 2012 was included in “post SAMMPRIS group”. Patients demographic, in-hospital complications and discharge destinations were compared between the two groups. We also assessed the frequency of procedures per year. Results: The frequency of Intracranial Stent placement decreased by approximately half in the post SAMMPRIS period. Three years prior to 2011, approximately 30 procedures were documented each year whereas in 2012 only 17 procedures were reported in the state (p < 0.0001). Age, gender, medical comorbidity, in-hospital complications, in-hospital mortality and discharge destination did not differ between the pre and post SAMMPRIS patient population (see Table). Conclusion: After the publication of SAMMPRIS results in 2011, the frequency of Intracranial Stent placement has decreased significantly. The patients who are currently offered this treatment do not appear to be different from population prior to SAMMPRIS publication. Disclosure: Dr. Siddiq has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Nickles has nothing to disclose. Dr. Qureshi has nothing to disclose.
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Intracranial Stent Placement for Symptomatic Intracranial Stenosis as Part of a Clinical Trial Versus Outside a Clinical Trial
Stroke, 2013Co-Authors: Farhan Siddiq, Malik M Adil, Kiersten Norby, Adnan I. QureshiAbstract:Background and Purpose—A high rate of postprocedure complications in the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial has raised concerns whether such results are representative of Intracranial Stent placement in actual routine practice. Methods—Using the Nationwide Inpatient Sample from 2008 to 2010, patients with cerebral ischemic events treated with Intracranial Stent as part of a clinical trial or outside the trial were identified. The composite end point (postoperative stroke, cardiac complications, and mortality) was reported. Results—Of the 3447 patients who underwent Intracranial Stent placement, 223 patients (6.5%) were enrolled in a clinical trial. The rate of composite end point was higher in patients treated outside clinical trials compared with those treated within clinical trials (14.2% versus 4.5%; P=0.1). The proportion of patients discharged to home was higher in those treated in clinical trials (76.8% versus 49.6%; P=0.001). Conclusions—I...
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Abstract 58: Rates Of Postoperative Stroke, Cardiac Complication And Mortality In Patients Undergoing Intracranial Stent Placement As Part Of A Clinical Trial Versus Those Treated Outside A Clinical Trial
Stroke, 2013Co-Authors: Farhan Siddiq, Malik M Adil, Adnan I. QureshiAbstract:Background: The pre-maturely discontinued Stenting versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial demonstrated lack of benefit of Intracranial Stent placement due to high rates of immediate post procedure complications. The rates of complications were higher than those reported previously raising the question whether such results were representative of Intracranial Stent placement in actual routine practice. Objective: To ascertain and compare the rate of outcomes between patients who underwent Intracranial Stent placement within and outside clinical trials. Materials/Methods: Using the Nationwide Inpatient Sample (NIS) from 2008 to 2010, patients with cerebral ischemic events who underwent Intracranial Stent placement were identified using ICD-9 diagnosis and procedure codes. Patients were divided into those who received Intracranial Stent placement as part of the clinical trial and those who were treated outside any trial. The postoperative mortality, stroke and cardiac complications were primary endpoints. Results: A total of 3447 patient underwent Intracranial Stent placement, 223 patients (6.5%) were enrolled in a clinical trial. Patients who received Intracranial Stent placement as part of the clinical trial were significantly younger (65±10 versus 68±13 years, p=0.008). Both groups did not differ in terms of gender, race and ethnicity and medical co-morbidities. Mean length of stay was longer in patients treated outside a clinical trial (9.1±11 versus 5.1±4, p Conclusions: Patients who undergo Intracranial Stent placement outside a clinical trial have higher rates of postoperative stroke, cardiac complication and mortality. Such results support those of the SAMMPRIS trial and the need for restricting these procedures to selected patients and specialized centers with high experience.