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Angioplasty and Stenting for Intracranial Atherosclerotic Stenosis With Nitinol Stent: Factors Affecting Technical Success and Patient Safety

Ho Yu, Simon Chun MD*; Hong Leung, Thomas Wai MBBS, FRCP; Yee Hung, Esther Hiu MBBS, FRCR*; Lee, Kwok Tung BSc*; Sing Wong, Lawrence Ka MD

doi: 10.1227/NEU.0b013e3182320bb0
Technique Assessment

BACKGROUND: Angioplasty and stenting using nitinol stents is a recognized treatment option for intracranial atherosclerosis.

OBJECTIVE: To identify procedure-related factors that may affect patient safety and technical outcome.

METHODS: In this prospective study of 57 consecutive patients, the primary end points were intraprocedural technical problems, periprocedure morbidity, and complications. Major periprocedure complication was defined as all stroke or death at 30 days. Technical failure was defined as the inability to complete the procedure because of technical or safety problems. Procedure failure was defined as a procedure outcome of technical failure or major periprocedure complication. Secondary end points were procedure-related factors that may affect patient safety and technical outcome.

RESULTS: Procedure failure rate was 12.3% (7/57) (major periprocedure complication rate, 5.3% [3/57]; technical failure rate, 7% [4/57]). Initial failure in tracking of balloon or stent occurred in 20 patients, other technical problems occurred in 11 patients, including kinking or trapping of balloon catheter (2 cases), difficulty in unsheathing of stent (3 cases), forward migration of stent during deployment (4 cases), trapping of nose cone after stent deployment (1 case), fracture of delivery system (2 cases), and guidewire fracture (1 case). Unfavorable vascular morphology signified by the presence of 2 or more reverse curves along the access path was found to associate with initial failure in the tracking of instruments (OR = ∞), and occurrence of other technical problems (OR = 25).

CONCLUSION: Procedure-related factors could be identified and lead to improvements in patient safety and technical outcome. Tortuous vascular morphology is a key factor to be overcome.

*Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The New Territories, Hong Kong

Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, The New Territories, Hong Kong

Correspondence: Simon Chun Ho Yu, MD, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30–32 Ngan Shing Street, Shatin, The New Territories, Hong Kong. E-mail: simonyu@cuhk.edu.hk

Received May 10, 2010

Accepted June 6, 2011

Copyright © by the Congress of Neurological Surgeons