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Purpose: To investigate the safety and efficacy of Enterprise stent angioplasty and risk factors for the prognoses in treating symptomatic severe posterior circulation atherosclerotic stenosis (SSPCAS). Materials and methods: Patients with SSPCAS who were treated with the Enterprise stent angioplasty were retrospectively enrolled. The clinical data, peri-procedural complications, postoperative residual stenosis, in-stent restenosis and recurrent stroke at follow-up were analyzed. Results: 262 patients with 275 stenotic lesions treated with the Enterprise stent angioplasty were enrolled. The stenosis degree was reduced from 86.3 ± 6.2% before to 19.3 ± 5.4% after stenting. Complications occurred in 14 (5.3%) patients. Clinical follow-up was performed in 245 (93.51%) patients for 16.5 ± 7.3 months. During 1 year follow-up, 7 patients (2.9%) had recurrent symptoms, including 4 patients with stenting in the intracranial vertebral artery and 3 in the basilar artery. Imaging follow-up was conducted in 223 (85.11%) patients. In-stent restenosis was present in 35 patients (15.7%), with the restenosis rate of 26.4% (n = 23) in the intracranial vertebral artery, which was significantly (P < 0.001) greater than in the basilar artery (8.8%). Six patients (17.1%) with in-stent restenosis were symptomatic. The stenotic length was the only significant (P = 0.026 and 0.024, respectively) independent risk factor for 1 year stroke or death events and in-stent restenosis. Conclusion: The Enterprise stent can be safely and efficaciously applied in the treatment of symptomatic severe posterior circulation atherosclerotic stenosis, with a relatively low rate of in-stent restenosis and recurrent stroke within 1 year. The stenotic length was the only significant independent risk factor for 1 year stroke or death events and in-stent restenosis. [ABSTRACT FROM AUTHOR]

• At the proximal normal artery, the total pressures had significantly (P<0.05) decreased, whereas all the other hemodynamic parameters increased after stenting. • At the stenosis, all hemodynamic parameters had significantly decreased after stenting. • At the stenosis perforating branch, the shear stress, cell Reynolds number, velocity, and vorticity were all significantly decreased, and the total pressure, turbulence intensity, kinetic energy, and dissipation rate were all significantly increased after stenting. • At the distal normal artery, the total flow pressure (perfusion pressure) and velocity were both significantly (P<0.05) increased, and the total pressure, shear stress, cell Reynolds number, vorticity, turbulence intensity, kinetic energy, and dissipation rate were all significantly (P<0.05) decreased. • Sub-satisfactory recanalization has significantly restored the stenosis and improved the hemodynamic parameters near the stenosis and at the root of the perforating branch. To investigate the effect of sub-satisfactory stenting recanalization of severe vascular stenosis of the posterior circulation on cerebral hemodynamic perfusion. Patients with severe vascular stenosis of the posterior circulation who had undergone three-dimensional cerebral angiography before and after stenting were retrospectively enrolled. Computational fluid dynamic (CFD) analysis of hemodynamic parameters at the stenosis, perforating branch, and normal arterial segments proximal and distal to the stenosis were performed. Sixty-two patients with basilar artery stenosis aged 60.9 ± 9.6 years were enrolled, and stent angioplasty resulted in the reduction of stenosis degree from 85.3 ± 7.2% before to 18.6 ± 6.4% after stenting. After stenting, at the proximal normal artery, the total pressures had significantly (P < 0.05) decreased, whereas all the other parameters (WSS, cell Reynolds number, velocity, vorticity, turbulence intensity, turbulence kinetic energy and dissipation rate) had significantly (P < 0.05) increased. At the stenosis, all hemodynamic parameters had significantly decreased. At the stenosis perforating branch, the WSS, cell Reynolds number, velocity, and vorticity were all significantly decreased, and the total pressure, turbulence intensity, kinetic energy, and dissipation rate were all significantly increased. At the distal normal artery, the total flow pressure (perfusion pressure) and velocity were both significantly (P < 0.05) increased, and the total pressure, WSS, cell Reynolds number, vorticity, turbulence intensity, kinetic energy, and dissipation rate were all significantly (P < 0.05) decreased. The hemodynamic parameters after stenting were closer to those after virtual stenosis repair at all measurements. Sub-satisfactory recanalization has significantly restored the stenosis and improved the hemodynamic parameters near the stenosis and at the root of the perforating branch, thus significantly improving the cerebral perfusion, similar to the changes of hemodynamic status and cerebral perfusion after virtual removal of the vascular stenosis. This may indicate the good effect of sub-satisfactory stenting recanalization of the vascular stenosis at the posterior circulation. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety and long-term effect of using the Wingspan stent for severe symptomatic atherosclerotic basilar artery stenosis (≥70%). Materials and methods Between July 2007 and April 2013, we had 91 consecutive patients (age range 41–82 years old) with symptomatic severe basilar stenosis (70–99%) who underwent Wingspan stenting at our center. All patients had stenosis-related temporary ischemic attack or strokes. We analyzed the demographic data, pre- and post-procedural cerebral angiography, technical success rate, peri-procedural complications, and clinical and imaging follow-ups. Results The Wingspan stenting procedure was successful in all patients: The stenosis was reduced from 82.2% ± 5.8% pre-stenting to 15.9% ± 5.7% post-stenting. The 30-day peri-operative rate for stroke or death was 14.3%, which included ischemic stroke in 12 cases (12/91 = 13.2%) and subarachnoid hemorrhage in one case (1/91 = 1.1%), with a fatal or disabling stroke rate of 2.2%. Among the 77 patients with clinical follow-up assessment within 7–60 months (mean 31.3 ± 15.1 months) after stenting, four patients (5.2%) had posterior ischemia, including one patient with disabling ischemic stroke (1.3%) and three patients (3.9%) with temporary ischemic attack. The 2-year cumulative stroke rate was 16% (95% CI: 8.2–23.8%). Among 46 patients with imaging assessments at 3–45 months (mean, 9.5 ± 8.3) post-stenting, six (13.0%) patients had restenosis, including two (2/46 = 4.3%) with symptomatic restenosis. Conclusions The benefit of stenting for patients with severe basilar artery stenosis (> 70%) may lie in lowering the long-term fatal and disabling stroke rate; and as long as the peri-operative stroke rate can be kept at a relatively lower level, patients with severe basilar stenosis can benefit from basilar artery stenting. [ABSTRACT FROM AUTHOR]

Introduction: This study was to investigate the periprocedural stroke rates, safety, and long-term effect of Wingspan stenting for symptomatic severe stenosis of the middle cerebral artery (MCA) at a high-volume center. Methods: Between July 2007 and April 2013, 196 consecutive patients with severe MCA atherosclerotic stenosis (≥70 %) who were treated with Wingspan stenting were retrospectively studied. All patients had arterial stenosis-related temporary ischemic attack or strokes. The demographic data, cerebral angiography, technical success rate, periprocedural complications, and clinical and imaging follow-up were analyzed. Results: The successful stenting rate was 98.0 %, and the stenosis rate was improved from pre-stenting (80.6 ± 8.3 %) to post-stenting (15.5 ± 6.8 %). The 30-day periprocedural stroke or death rate was 7.1 %, with a disabling or fatal rate of 2.6 %. The perioprocedural stroke rate was significantly ( P < 0.01) greater in the early learning stage (16.0 %) than in the later technical maturation stage (4.1 %). The total periprocedural ischemic and perforator stroke rates were greater in patients with the most stenosis in the distal MCA 1/3 segment (6.8 and 5.7 %, respectively) than in the proximal and middle 2/3 segments (0.9 and 0 %, respectively). The ipsilateral stroke or death rate beyond 30 days (6-69 months, mean 30 ± 16) was 4.8 %, with the 1- and 2-year cumulative stroke rates of 9.6 and 12.1 %, respectively. Imaging follow-up 6-69 months (mean 10.9 ± 8.5) revealed restenosis in 21 cases (20.4 %). Conclusion: Intracranial stenting of MCA stenoses may have the potential of better clinical outcomes if patients are properly selected and treated by an experienced operator at a high-volume center. [ABSTRACT FROM AUTHOR]

Background Symptomatic sinus occlusion complicated with dural arteriovenous fistulas (dAVFs) can be treated successfully endovascularly. However, no studies have reported the use of endovascular transvenous approaches alone to recanalize the occluded sinuses for treatment of the involved dAVFs without stent deployment. In this study, we presented a 75-year-old man with occlusion of the transverse and sigmoid sinuses complicated with a dAVF. Case Description This patient initially suffered intermittent headache, nausea, and vomiting but developed seizures and hemiplegic paralysis 2 months later. Neurologic examination revealed mildly decreased motor function in grade IV in the left limb. Intracranial pressure by lumbar puncture was 300 mm H 2 O. Magnetic resonance imaging venography disclosed sinus occlusion and dAVFs accounting for encephaledema. Cerebral angiography revealed occlusion of the left transverse and sigmoid sinuses and cortical reflux with the sinus junction unobstructed. The feeding arteries of the left transverse sinus dAVFs were muscular branches of the left vertebral artery and external carotid artery, and the draining vein was from the superior sagittal sinus to the contralateral transverse sinus. Balloon angioplasty plus mechanical cracking (pulling a microcatheter back and forth) was used to recanalize the occluded sinuses. The symptoms disappeared after endovascular recanalization of the occluded left transverse sinus and sigmoid sinuses, and follow-up venography revealed opened sinuses with complete disappearance of the dAVF. Conclusion Endovascular transvenous recanalization may be a better alternative therapy for selected patients with dural arteriovenous fistulas complicated by sinus occlusion without stent deployment. [ABSTRACT FROM AUTHOR]