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BackgroundAlthough endovascular treatment (EVT) has become the standard treatment for acute large vessel occlusion (LVO), its safety and efficacy in older adults have not been fully determined. The present study aimed to compare the safety and efficacy of EVT for acute LVO between younger (MethodsThe subjects were selected from the ANGEL-ACT registry (endovascular treatment key technique and emergency workflow improvement of acute ischemic stroke). The 90-day modified Rankin score (mRS), successful recanalization, procedure duration, number of passes, intracranial hemorrhage (ICH), and mortality within 90 days were compared after adjusting for confounders.ResultsA total of 1,691 patients, 1,543 classified as young and 148 classified as older, were included. We observed that young and older adults had a similar 90-day mRS distribution, successful recanalization, procedure duration, number of passes, ICH, and mortality within 90 days (all p > 0.05). The rate of 90-day mRS 0–3 was found to be higher in young patients than in older adults (39.9% vs. 56.5%, odds ratio = 0.64, 95% confidence interval = 0.44–0.94, p = 0.022).ConclusionWe found that patients less than or greater than 80 years of age share similar clinical outcomes, without increasing the risk of ICH and mortality.

Supplemental material, sj-docx-1-wso-10.1177_17474930221150111 for Incidence, predictors, and impact on outcome of underlying intracranial atherosclerotic disease in acute vertebrobasilar artery occlusion undergoing endovascular therapy: Data from ANGEL-ACT registry by Kangyue Li, Dapeng Sun, Xu Tong, Anxin Wang, Yijun Zhang, Gaoting Ma, Xiaochuan Huo, Ning Ma, Feng Gao, Dapeng Mo, Xuan Sun, Guangge Peng, Xuelei Zhang, Baixue Jia and Zhongrong Miao in International Journal of Stroke

Background and ObjectivesDeclines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020).MethodsWe conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by theirICD-10codes or classifications in stroke databases.ResultsThere were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1–6.9];p< 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1–4.6];p< 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4–5.8];p< 0.0001). Larger declines were observed at high-volume compared with low-volume centers (allp< 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6–0.9];p= 0.49). Stroke was diagnosed in 1.3% [1.31–1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82–2.97], 5,656/195,539) of all stroke hospitalizations.DiscussionThere was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.Trial Registration InformationThis study is registered underNCT04934020.

Supplemental material, sj-docx-1-ine-10.1177_15910199231164840 for Association between basilar artery stenosis features, vertebral artery stenosis and perforator stroke after stenting by Rui Huang, Bo Yang, Feng Gao, Dapeng Mo, Ming Yang, Zhikai Hou, Yifan Liu, Rongrong Cui, Kaijiang Kang, Weibin Gu, Jianfeng He, Xin Lou, Zhongrong Miao and Ning Ma in Interventional Neuroradiology

Supplemental material, sj-docx-1-ine-10.1177_15910199231164840 for Association between basilar artery stenosis features, vertebral artery stenosis and perforator stroke after stenting by Rui Huang, Bo Yang, Feng Gao, Dapeng Mo, Ming Yang, Zhikai Hou, Yifan Liu, Rongrong Cui, Kaijiang Kang, Weibin Gu, Jianfeng He, Xin Lou, Zhongrong Miao and Ning Ma in Interventional Neuroradiology

© 2022 American Academy of Neurology, Background and objectives: Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). Methods: We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results: There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1-6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1-4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4-5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6-0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31-1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82-2.97], 5,656/195,539) of all stroke hospitalizations. Discussion: There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.

In 2015, several clinical trials demonstrated the efficacy of endovascular reperfusion therapies (EVT) in stroke patients with large vessel occlusion, which had changed stroke treatment guidelines and clinical practice all over the world. However, despite substantial recanalization, about half of the patients obtain a poor functional outcome at 3 months after endovascular treatment. The difference between the high recanalization rate of cerebral vessels and the low recovery rate of good clinical function has become a pain for neurointerventionalists! Alberta stroke program early CT score (ASPECTS), direct arrival, previous thrombolysis, time from onset to recanalization < 6 h, and recanalization status, etc. are certainly the reasons for this outcome. But we may have overlooked an important issue, that recanalization of blood vessels does not mean reperfusion of tissues. The phenomenon of poor tissue perfusion after recanalization is called no-reflow phenomenon (NRP). Coronary NRP has become an important predictor of clinical prognosis for acute coronary occlusion after percutaneous coronary intervention (PCI). In the past nearly half century, interventional cardiologists have done a lot of researches on the pathogenesis, diagnosis and treatment of NRP, which effectively improve the clinical efficacy of coronary PCI. When neurointerventionalists are actively carrying out endovascular treatment for acute ischemic stroke, should they actively pay more attention to NRP?

Background and purposeTo investigate the safety and efficacy of oral antiplatelet therapy (APT) for patients who had acute ischaemic stroke (AIS), receiving endovascular therapy (EVT).MethodsPatients were divided into non-APT group and APT (single APT or dual APT (DAPT)) group. The safety and efficacy endpoints at 3-month follow-up were symptomatic intracranial haemorrhage (sICH), recanalisation rate, clinical outcome and mortality.ResultsAmong 915 patients who had AIS, those in APT group (n=199) showed shorter puncture-to-recanalisation time, lower frequency of intravenous thrombolysis and more use of tirofiban compared with those in non-antiplatelet group (n=716) (pConclusionsOral APT prior to undergoing EVT is safe and may accompany with superior clinical outcomes. DAPT may associate with superior clinical outcomes and lower risk of mortality.

Supplemental material, sj-pdf-3-jcb-10.1177_0271678X221086408 for Prediction of the trans-stenotic pressure gradient with arteriography-derived hemodynamic features in patients with idiopathic intracranial hypertension by Yupeng Zhang, Chao Ma, Changxuan Li, Xiaoqing Li, Raynald Liu, Minke Liu, Haoyu Zhu, Fei Liang, Yilong Wang, Kehui Dong, Chuhan Jiang, Zhongrong Miao and Dapeng Mo in Journal of Cerebral Blood Flow & Metabolism

Supplemental material, sj-docx-1-ine-10.1177_15910199221125853 for Outcome prediction value of critical area perfusion score for acute basilar artery occlusion by Dapeng Sun, Xiaochuan Huo, Raynald, Dapeng Mo, Feng Gao, Ning Ma, Gregory W Albers and Zhongrong Miao in Interventional Neuroradiology

Supplemental material, sj-docx-1-ine-10.1177_15910199221125853 for Outcome prediction value of critical area perfusion score for acute basilar artery occlusion by Dapeng Sun, Xiaochuan Huo, Raynald, Dapeng Mo, Feng Gao, Ning Ma, Gregory W Albers and Zhongrong Miao in Interventional Neuroradiology

Supplemental material, sj-pdf-1-jcb-10.1177_0271678X221086408 for Prediction of the trans-stenotic pressure gradient with arteriography-derived hemodynamic features in patients with idiopathic intracranial hypertension by Yupeng Zhang, Chao Ma, Changxuan Li, Xiaoqing Li, Raynald Liu, Minke Liu, Haoyu Zhu, Fei Liang, Yilong Wang, Kehui Dong, Chuhan Jiang, Zhongrong Miao and Dapeng Mo in Journal of Cerebral Blood Flow & Metabolism

Supplemental material, sj-docx-1-tan-10.1177_17562864221143178 for Association of periprocedural perfusion non-improvement with recurrent stroke after endovascular treatment for Intracranial Atherosclerotic Stenosis by Long Yan, Zhikai Hou, Weilun Fu, Ying Yu, Rongrong Cui, Zhongrong Miao, Xin Lou and Ning Ma in Therapeutic Advances in Neurological Disorders

Supplemental material, sj-pdf-2-jcb-10.1177_0271678X221086408 for Prediction of the trans-stenotic pressure gradient with arteriography-derived hemodynamic features in patients with idiopathic intracranial hypertension by Yupeng Zhang, Chao Ma, Changxuan Li, Xiaoqing Li, Raynald Liu, Minke Liu, Haoyu Zhu, Fei Liang, Yilong Wang, Kehui Dong, Chuhan Jiang, Zhongrong Miao and Dapeng Mo in Journal of Cerebral Blood Flow & Metabolism

Background and purposeHyperperfusion (HP) is a devastating complication associated with carotid artery stenting (CAS) or endarterectomy. The efficacy and safety of staged angioplasty (SAP) in patients with CAS at high risk of HP remains unclear. We sought to determine whether SAP is superior to regular CAS in patients with high risk of HP.MethodsA randomised, multicentre open-label clinical trial with blinded outcome assessment (STEP) was conducted. Patients with severe carotid stenosis at high risk of HP were randomly assigned (1:1) to the SAP or regular CAS group. The primary endpoint was hyperperfusion syndrome (HPS) and intracerebral haemorrhage (ICH) within 30 days after the procedure.ResultsFrom November 2014 to January 2017, a total of 64 patients were enrolled in 11 centres. 33 patients were allocated to the SAP group and 31 to the regular CAS group. At 30 days, the rate of primary endpoint was 0.0% (0/33) in the SAP group and 9.7% (3/31) in the regular CAS group (absolute risk reduction (ARR), 9.7%; 95% CI −20.1% to 0.7%; p=0.11). As one of the secondary endpoints, the incidence of HP phenomenon (HPP) was lower in the SAP group than the regular CAS group (0.0% vs 22.6%, ARR,−22.6%; 95% CI −36.8% to −10.2%; p=0.04).ConclusionThe rate of HPS and ICH was not significantly lower in SAP group; the extended secondary endpoint of HPP, however, significantly reduced, which suggested that SAP may be a safe and effective carotid revascularisation procedure to prevent HP.Trial registration numberNCT02224209.

Background The COVID-19 pandemic has strained the healthcare systems across the world but its impact on acute stroke care is just being elucidated. We hypothesized a major global impact of COVID-19 not only on stroke volumes but also on various aspects of thrombectomy systems. Aims We conducted a convenience electronic survey with a 21-item questionnaire aimed to identify the changes in stroke admission volumes and thrombectomy treatment practices seen during a specified time period of the COVID-19 pandemic. Methods The survey was designed using Qualtrics software and sent to stroke and neuro-interventional physicians around the world who are part of the Global Executive Committee (GEC) of Mission Thrombectomy 2020, a global coalition under the aegis of Society of Vascular and Interventional Neurology, between April 5th to May 15th, 2020. Results There were 113 responses to the survey across 25 countries with a response rate of 31% among the GEC members. Globally there was a median 33% decrease in stroke admissions and a 25% decrease in mechanical thrombectomy (MT) procedures during the COVID-19 pandemic period until May 15th, 2020 compared to pre-pandemic months. The intubation policy for MT procedures during the pandemic was highly variable across participating centers: 44% preferred intubating all patients, including 25% of centers that changed their policy to preferred-intubation (PI) from preferred non-intubation (PNI). On the other hand, 56% centers preferred not intubating patients undergoing MT, which included 27% centers that changed their policy from PI to PNI. There was no significant difference in rate of COVID-19 infection between PI versus PNI centers (p=0.60) or if intubation policy was changed in either direction (p=1.00). Low-volume (20 strokes/month) were less likely to have neurointerventional suite specific written personal protective equipment protocols (74% vs 88%) and if present, these centers were more likely to report them to be inadequate (58% vs 92%). Conclusion Our data provides a comprehensive snapshot of the impact on acute stroke care observed worldwide during the pandemic. Overall, respondents reported decreased stroke admissions as well as decreased cases of MT with no clear preponderance in intubation policy during MT. Data access statement The corresponding author will consider requests for sharing survey data. The study was exempt from institutional review board approval as it did not involve patient level data.

IMPORTANCE: In-stent restenosis (ISR) is the primary reason for stroke recurrence after intracranial stenting in patients who were treated with a standard bare-metal stent (BMS). Whether a drug-eluting stent (DES) could reduce the risk of ISR in intracranial atherosclerotic stenosis (ICAS) remains unclear. OBJECTIVE: To investigate whether a DES can reduce the risk of ISR and stroke recurrence in patients with symptomatic high-grade ICAS. DESIGN, SETTINGS, AND PARTICIPANTS: A prospective, multicenter, open-label randomized clinical trial with blinded outcome assessment was conducted from April 27, 2015, to November 16, 2018, at 16 medical centers in China with a high volume of intracranial stenting. Patients with symptomatic high-grade ICAS were enrolled, randomized, and followed up for 1 year. Intention-to-treat data analysis was performed from April 1 to May 22, 2021. INTERVENTIONS: Patients were randomly assigned to receive DES (NOVA intracranial sirolimus-eluting stent system) or BMS (Apollo intracranial stent system) treatment in a 1:1 ratio. MAIN OUTCOMES AND MEASURES: The primary efficacy end point was ISR within 1 year after the procedure, which was defined as stenosis that was greater than 50% of the luminal diameter within or immediately adjacent to (within 5 mm) the implanted stent. The primary safety end point was any stroke or death within 30 days after the procedure. RESULTS: A total of 263 participants (194 men [73.8%]; median [IQR] age, 58 [52-65] years) were included in the analysis, with 132 participants randomly assigned to the DES group and 131 to the BMS group. The 1-year ISR rate was lower in the DES group than in the BMS group (10 [9.5%] vs 32 [30.2%]; odds ratio, 0.24; 95% CI, 0.11-0.52; P

Xiaochuan Huo,1,2,* Ming Yang,1,2,* Ning Ma,1,2 Feng Gao,1,2 Dapeng Mo,1,2 Xiaoqing Li,1,2 Anxin Wang,2,3 Yongjun Wang,2,3 Zhongrong Miao1,2 1Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China; 3Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhongrong MiaoBeijing Tiantan Hospital, Capital Medical University, No. 119, the South Fourth Ring West Road, Beijing, Fengtai District 100070, People’s Republic of ChinaEmail doctorzhongrongm@126.comPurpose: Whether tirofiban is safe and effective for acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) with preceding intravenous thrombolysis (IVT) remains unclear. We aim to evaluate the safety and efficacy of tirofiban during MT for patients with preceding IVT.Patients and Methods: Patients who underwent MT and preceding IVT were derived from the ANGEL registry and were dichotomized into tirofiban and non-tirofiban group according to whether rescue tirofiban was performed. The safety endpoints were sICH, total ICH and distal embolization. The efficacy endpoints were arterial recanalization, three-month functional independence (modified Rankin Scale [mRS]: 0– 2) and mortality.Results: We included 207 MT patients with preceding IVT from the entire registry. Among them, there were 55 in tirofiban group and 152 in non-tirofiban group, and 17 (8.2%) patients suffered sICH and 36 (17.4%) suffered ICH within 24 hours post-MT; 11 (5.3%) distal embolization of thrombus; 111 (53.6%) achieved functional independence and 34 (16.4%) died after three-month follow-up. No significant differences in safety outcomes on sICH, ICH and distal embolization of thrombus and efficacy outcomes on recanalization and long-term functional independence were found between tirofiban and non-tirofiban group for the entire cohort (p> 0.05 for all groups). Tirofiban was correlated with long-term mortality reduction for patients underwent MT and preceding IVT (adjusted hazard ratio 0.28 [0.08– 0.94], adjusted p=0.03).Conclusion: In AIS patients who underwent MT and preceding IVT, rescue tirofiban was not correlated with increased risk of safety endpoints on sICH, ICH or distal embolization of thrombus, and might be associated with a lower risk of long-term mortality. Further study is needed to confirm the effect of early antiplatelet therapy with tirofiban for patients underwent MT and preceding IVT.Keywords: acute ischemic stroke, mechanical thrombectomy, intravenous thrombolysis, tirofiban, bridging therapy

To investigate the predictors for good outcome of endovascular therapy (EVT) for patients with acute vertebrobasilar artery occlusion (VBAO) due to intracranial atherosclerosis stenosis (ICAS). From April 2012 to February 2018, patients with VBAO due to ICAS who received EVT were retrospectively analyzed. ICAS was defined as fixed stenosis of >70%, or a degree of fixed stenosis >50% in addition to either perfusion impairment or evidence to re-occlusion. Good outcome was defined as mRS≤2 at 90 days. Both logistic regression and receiver operating characteristic curve (ROC) analyses were performed to explore the predictors. Among 103 patients enrolled in the analysis, 40.8% achieved good outcome. Prior antiplatelet therapy (OR, 7.301; 95% CI, 1.761–30.265; P=0.006), EVT+IVT (OR, 7.343; 95% CI, 1.621–33.263; P=0.010 ), the pc-ASPECT on DWI (OR, 1.705; 95% CI, 1.127–2.580; P=0.012), BATMAN (OR, 1.395; 95% CI, 1.005–1.937; P=0047), general anesthesia (OR, 0.081; 95% CI, 0.010–0.633; P=0.017), onset-to-recanalization time (≤542min vs. >542min) (OR, 0.194; 95% CI, 0.057–0.661; P=0.009) and the initial NIHSS (OR, 0.882; 95% CI, 0.820–0.949; P=0.001) were significantly associated with good outcome in logistic regression. Based on ROC analyses, initial NIHSS score (area under the curve [AUC]= 0.816, p

Three-dimensional pseudocontinuous arterial spin labeling with multiple postlabeling delays has been used to assess cerebral blood flow (CBF). We used this modality to estimate antegrade and collateral flow in patients with unilateral middle cerebral artery stenosis.Consecutive patients with unilateral middle cerebral artery 50% to 99% stenosis at 2 centers underwent pseudocontinuous arterial spin labeling with a postlabeling delays of 1.5 and 2.5 s. Mean CBF of bilateral middle cerebral artery territory at the postlabeling delays 1.5 and 2.5 s was measured. Early-arriving flow proportion was defined as (CBF 1.5 s at lesion side/CBF 2.5 s at normal side)×100%. Late-arriving retrograde flow proportion was defined as ([CBF 2.5 s-CBF 1.5 s] at lesion side-[CBF 2.5 s-CBF 1.5 s] at normal side)/CBF 2.5 s at normal side×100%. Antegrade and collateral scales were evaluated in patients with conventional angiography. Spearman correlation coefficients were calculated between early-arriving flow and late-arriving retrograde flow proportions on arterial spin labeling and antegrade and collateral scales on conventional angiography, respectively.Forty-one patients (46.0±12.0 years) were enrolled. The mean early-arriving flow proportion was 78.3±14.9%. The mean late-arriving retrograde flow proportion was 16.1±10.2%. In 21 patients with conventional angiography, Spearman correlation coefficient was 0.53 (95% confidence interval, 0.11-0.79) between antegrade grade and early-arriving flow proportion (P=0.01) and 0.81 (95% confidence interval, 0.56-0.92) between collateral grade and late-arriving retrograde flow proportion (P0.0001).Three-dimensional pseudocontinuous arterial spin labeling with 2 postlabeling delays may provide an empirical approach for estimating antegrade and collateral flow in patients with unilateral middle cerebral artery stenosis.URL: http://www.clinicaltrials.gov. Unique identifier: NCT02479243.

Atherosclerotic intracranial artery stenosis can cause hypoperfusion of brain tissues and embolus formation, causing stroke. Conservative medical treatment seemed to have little effect on the natural history and prevent the stroke attack caused by artery stenosis. The purpose of stent-assisted angioplasty is to reconstruct the damaged vessels: the indications, feasibility, effectiveness, complications and follow-up for this new treatment method are discussed. A series of 32 cases with symptomatic intracranial artery stenosis were accepted from 1998 to 2002. The mean age was 42 yrs (31∼76 yr), male/female ratio=23/9. All patients were refractory to optimal medical therapy. Lesions included 12 middle cerebral arteries (37.5%), six basilar arteries (18.75%), three distal ICAs (9.38%) and 12 intracranial Vas (37.5%). All patients were treated by methods of transluminal stent-assisted angioplasty under general anesthesia. Patients were premedicated with Aspirin (300mg/per day) and Ticlopidine (250mg/per day), this was continued for six weeks after the procedure. Medical history, anamnesis, and treatment protocol were reviewed and evaluated retrospectively, short-term follow-up (2mths ∼ 1 yr) was also obtained. Primary clinical presentations were TIAs (21/32, 65.63%), minor stroke (8/32, 25%) and severe stroke (3/32, 9.38%). 31 cases (96.86%) were successfully implanted with coronary stents within the stenosed vessels; technical success rate was 96.86%. Instant angiographic results showed the stenosed extent had decreased from 72.36%±5.69 to 10.16%±6.94. One vessel ruptured during the procedure, the patient recovered after surgical repair of the ruptured vessel. Clinical follow-up demonstrated symptoms resolved in most patients (30/32, 93.75%) within the follow-up period, two cases with MCA stenosis had TIAs within two months after the procedure. 12 cases accepted angiographic follow-up. Velocities of stented vessels of five cases (5/21, 23.81%) increased compared to instant results, suggesting restenosis, three of them were confirmed by angiography which included two cases with MCA stenosis (figure 3) and one with distal VA, one of the five cases had recurred TIAs. With the newer generation of coronary stent, this technique seemed safe, feasible and effective to prevent stroke attack, but the indication is very important for the technical success. Restenosis remains a common problem as with coronary stenting. Long-term follow-up will be needed.

Background and Purpose: High periprocedural complication rate is a key limitation of endovascular treatment of intracranial atherosclerotic disease (ICAD) despite potential risk reduction of recurrent stroke. Based on the SAMMPRIS trial, with modification of the target population and tailored angioplasty, we prospectively evaluated efficacy and safety of a novel endovascular approach for patients with ICAD. Methods: From November 2011 to October 2012, 156 patients were consecutively recruited into a prospective single-center study. Patients were divided into 3 groups based on 4 angioplasty methods: Apollo (A) Group, Gateway/Gateway+Stent (G-GS) group, and Gateway+Wingspan (GW) Group. The primary endpoints were successful procedure rate and any vascular event within 30 days. Results: Overall technical success rate was 96.8% (151/156). Intracranial stenting was successful in 97.6% of patients in group A and only 91.2% in group G-GS with no significant differences between three groups (p=0.213). The 30-day composite stroke or death rate was 4.5% (7/156). Stroke occurred in 4 patients of group A and in 3 patients of group GW. 140 (89.7%) patients had no any neurological deficit and no patient died during 30-day follow-up. Conclusions: Individual treatment of ICAD using tailored devices according to lesion morphology was feasible and safe in patients with limited collateral circulation.