Semptomatik Ýntrakranyal Arter Darlýðýnda Endovasküler Tedavi: Ýki Merkez Deneyimi

Amaç: Çalýþmamýz, semptomatik intrakraniyal stenozu olan ve medikal tedaviye yeterli yanýt vermeyen hastalarda endovasküler tedavinin etkinliðini ve klinik sonuçlarýný deðerlendirmeyi amaçlamaktadýr.
Gereçler ve Yöntemler: Aralýk 2021 ile Aralýk 2023 tarihleri arasýnda yüksek dereceli (%70-%99 þiddetinde) intrakranyal aterosklerotik darlýk tespit edilen, son 3 hafta içerisinde akut iskemik veya hemorajik enfarkt geçirmeyen, baþlangýçta modifiye edilmiþ Rankin Skalasý (mRS) ≤3 olan, en iyi medikal tedavi almasýna raðmen GÝA veya non-disabling stroke geçiren majör intrakranyal arter stenozu olup endovasküler tedavi uygulanan 32 hasta çalýþmaya dahil edildi. Teknik ve klinik baþarý oranlarý, mortalite ve komplikasyon oranlarý kaydedildi.
Sonuçlar: Calismaya dahil edilen 32 hastanýn %62.5’i (n=20) erkek, yaþlari 66.4 ± 10,09 yýl idi. Hastalarýn %43.8 (n=14)’i intrakranial internal karotid arterde, %37.5 (n=12)’I intradural vertebral arterde, %12.5 (n=4) orta serebral arterde ve %6.3 (n=2)'ü baziler arterde idi. Teknik baþarý oraný %100, Klinik basari %87.5 idi. Ýþlem öncesi stenozun derecesi ortalama %91.7 ± 6.3, iþlem sonrasý rezidu stenoz ise %22.1 ± 4.7 idi. Kullanýlan stentler: neuroform atlas 18 adet (%56.3), credo 8 adet (%25), koroner balon ekspandable 4 adet (%12.5) ve LVIS 2 adet (%6.3).Hastalarin 28(%87,5) inde Ilk 30 gün içerisinde herhangi bir sepmtom olmadi. 2 (%6.2) hastada iskemik inme, 1 (%3.1) hastada hemorajik inme ve 1 (%3.1) hastada mortalite oldu.
Çýkarýmlar: Özenle seçilmiþ hastalarda endovasküler tedavi, endovasküler tedavi alt tiplerinin kiþiye özel seçimi ve hastayý iþlem öncesi, iþlem sýrasýnda ve iþlem sonrasý dönemde yöneten deneyimli multidisipliner bir ekip, semptomatik ICAS olan hastalarýn güvenli ve etkili tedavisini saðlama potansiyeline sahiptir. (SETB-2024-04-063)

Endovascular Treatment in Symptomatic Intracranial Artery Stenosis: Experience from Two Centers

Objectives: To assess the efficacy of endovascular treatment and clinical outcomes in individuals with symptomatic intracranial
stenosis who had not responded adequately to medical intervention.
Methods: The study included 32 patients who received endovascular treatment due to high-grade (70%-99% severity) intracranial atherosclerotic stenosis from December 2021 to December 2023. The patients had not experienced any acute ischemic or hemorrhagic infarction within the last three weeks, had a Modified Rankin Scale score of ≤3 at baseline, and developed a transient ischemic attack or non-disabling stroke despite having received the best medical treatment. Technical and clinical success, mortality, and complication rates were recorded.
Results: Of the 32 patients included in the study, 62.5% (n=20) were male, and the mean age was 66.4±10.09 years. Stenting was performed on the intracranial internal carotid artery in 43.8% (n=14) of the patients, the intradural vertebral artery in 37.5% (n=12), the middle cerebral artery in 12.5% (n=4), and the basilar artery in 6.3% (n=2). The technical success rate was 100%, and the clinical success rate was 87.5%. The mean degree of stenosis before the procedure was 91.7±6.3%, and the degree of residual stenosis after the procedure was 22.1±4.7%. The Neuroform Atlas® stent system was used in 18 cases (56.3%), Credo® stents in eight (25%), coronary balloon-expandable stents in four (12.5%), and the LVIS® stent system in two (6.3%). Twenty-eight (87.5%) patients did not have any symptoms in the first 30 days, while two (6.2%) patients had an ischemic stroke, one (3.1%) patient had a hemorrhagic stroke, and one (3.1%) died.
Conclusion: Endovascular treatment in carefully selected patients, a tailored selection of treatment subtypes, and an experienced multidisciplinary team overseeing the patient before, during, and after the procedure have the potential to provide safe and effective treatment for patients with symptomatic intracranial atherosclerotic stenosis.