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Objective To evaluate the safety and efficacy of the use of Enterprise stent in the treatment of symptomatic intracranial atherosclerotic stenosis (sICAS) . Methods The clinical data of 27 patients with sICAS, who were treated with Enterprise stent implantation at First Affiliated Hospital of Zhengzhou University, China, during the period from January 2012 to December 2017, were retrospectively collected. The patient's basic parameters, characteristics of target lesions, technical success rate, perioperative safety and follow-up results were analyzed. Results A total of 27 patients (28 lesions in total) were enrolled in this study, and a total of 28 Enterprise stents were implanted. The preoperative mean stenosis degree of lesions was (75.7 ±6.7) ％, the postoperative residual stenosis degree was (23.2 ±16.6) ％. The technical success rate was 100％. Postoperative complication of perforating branch events occurred in 2 patients. No severe complications such as hemorrhage, artery dissection, in-stent thrombosis, hyper-perfusion syndrome, or cardiovascular events occurred. All patients were followed up for (10.8±9.1) months, and 3 instent restenosis lesions (≥50％) were detected although the patients had no target lesion-related symptoms, the incidence of in-stent restenosis was 10.7％. No newly-developed stroke caused by responsible blood vessel, bleeding events or death occurred. Conclusion For the treatment of sICAS, balloon dilatation followed by Enterprise stent implantation is technically feasible, and clinically safe and effective. The incidence of perioperative complications is low and the follow-up results are satisfactory. Further randomized controlled trials are still needed before its long-term efficacy is clarified.
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Objective: To evaluate the safety and efficacy of using Enterprise stents for the treatment of complex and severe symptomatic intracranial atherosclerotic stenosis (ICAS). Methods: From January 2012 to August 2018, the clinical and imaging data of 42 consecutive patients with complex and severe symptomatic ICAS received Enterprise stenting due to ineffective drug treatment at the Department of Neurology,the Affiliated Hospital of Guilin Medical University were analyzed retrospectively. The morphology, technical success rate, perioperative complications, clinical and imaging follow-up results of intracranial artery stenosis were analyzed. Results: Among 42 patients,preoperative DSA indicated that 11 patients had intracranial vertebral artery stenosis,6 had basilar artery stenosis,21 had middle cerebral artery stenosis, and 4 had intracranial segment stenosis of internal carotid artery. The success rate of Enterprise stenting was 100% (42/42). After operation, the mean stenosis rate was significantly lower than that before operation (20 ± 3% vs. 82 ± 5%; t = 32. 5, P = 0. 001), and the residual stenosis rate of posterior circulation was higher than that of anterior circulation (24 ±3% vs. 17 ± 3%; t =2. 074, P = 0. 045). Complications occurred in 3 patients (7. 1%) during the perioperative period. One of them with middle cerebral artery stenosis died of cerebral hemorrhage after operation. Two patients had detachment of thrombi during operation, and the blood flow recovered smoothly after drug thrombolysis and stent treatment. During a follow-up period of 16 ±2 months,the in-stent restenosis occurred in 2 patients after V4 segment operation of vertebral artery. Conclusions: The technical success rate of Enterprise stents is high for the treatment of complex and severe symptomatic ICAS. The treatment is relatively safe,and the short-and medium-term efficacy is better. Clinically, patients with higher risk of using Wingspan stents may choose Enterprise stents as an alternative.
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Objective To compare the effect of Solitaire AB and Enterprise stent-assisted endovascular embolization of intracranial wide-necked aneurysms. Methods The clinical data 218 patients with intracranial aneurysm treated with Solitaire AB stent or Enterprise stent in Guangdong General Hospital from January 2012 to December 2014 were analyzed retrospectively. Seventy patients were treated with Solitaire AB stents and 148 were treated with Enterprise stents. They were followed up after procedure (2 months to 2 years). The Raymond grade and the modified Rankin scale (mRS)scores were used to compare the efficacy of the 2 kinds of stents. Results There were no significant differences in patients before procedure in the Hunt-Hess grade (Z = 1. 550,P = 0. 121),Fisher grade (Z =1. 537,P =0. 124),aneurysm size (Z =0. 192,P =0. 848),and position (χ2 = 0. 337,P = 0. 736)between the 2 stent groups,while there were no significant differences in patients after procedure in the instant Raymond grade (Z = 0. 682,P = 0. 495), follow-up Raymond grade (Z = 0. 206,P =0. 837),and mRS score (P =0. 662)between the 2 stent groups. Further multivariate Logistic regression analysis showed that the stent type (Solitaire AB stent or Enterprise stent),Raymond grade follow-up grade (OR,0. 029 ,95% CI 0. 126 - 0. 199,P = 0. 661 ),and postoperative mRS score (OR,2. 000,95% CI 0. 204 - 19. 603,P = 0. 552)had no influence on the prognosis. Conclusions In the assisted embolization of intracranial wide-necked aneurysms using the Solitaire AB and Enterprise stents,the effects of both stents are good in the assisted embolization of intracranial wide-necked aneurysms.
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Objective To evaluate the safety and efficacy of Enterprise stent in the treatment of severe symptomatic basilar artery atherosclerosis stenosis.Methods All patients who underwent Enterprise stent for the treatment of symptomatic basilar artery atherosclerotic stenosis in our center from Nov.2011 to Nov.2014 were enrolled in the study.Preoperative and postoperative dual antiplatelet drugs and intensive lipid-lowering therapy were given to all the patients.Multi-modality imaging guiding for stent angioplasty was performed in all the patients, including head MRI or CT, CT or MRI perfusion, high resolution MRI for plaque analysis and angiography.Angiography after 6 months was recommended.The main outcome parameters were any stroke or death within 30 days, stroke recurrence in the basilar artery blood supply area during the follow-up period and in-stent restenosis.Results A total of 35 cases were enrolled in the study with operation technical success rate of 100％.The average preoperative and postoperative stenosis rate was (83.0-10.1)％ and (28.1 ±8.9)％.The main perioperative complication and mortality rate was 0.The average follow-up period was (10.6 ±7.9) months.During follow-up period, only 2 cases (5.7％) of TIA related to the stented artery were observed.In patients with follow-up period more than 6 months, 17 cases (56.7％) underwent cerebral angiography.Restenosis rate was 17.6％.One patient with in-stent restenosis suffered from transient cerebral ischemia and received another Enterprise stenting successfully.Conclusion Long term follow-up results show that Enterprise stent for the treatment of symptomatic basilar artery severe stenosis is safe and recurrence of stroke can be prevented effectively.
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Objective To analyze the intraoperative and postoperative common complications of Enterprise stent-assisted embolization of intracranial aneurysms and the causes and preventive measures. Methods One hundred forty-three patients with intracranial aneurysm treated with Enterprise stent-assisted embolization at the Department of Neurosurgery,Yijishan Hospital,the First Hospital Affiliated to Wannan Medical College from January 2012 to March 2014 were analyzed retrospectively. The common intraoperative and postoperative complications and its possible causes,as well as the appropriate management were analyzed,and the prognoses were observed. Results A total 143 patients(205 aneurysms)with intracranial aneurysm were enrolled,included 43 with unruptured aneurysm,12 with recurrent aneurysm,and 88 with ruptured aneurysm. A total of 170 Enterprise stents were used. Twenty-two patients (15. 4%)had complications. Among them,2 had intraoperative aneurysm rupture,and they recovered well and discharged after active treatment. Thirteen patients had acute thrombosis,11 of the patients completely restored blood flow immediately after tirofiban and/or urokinase,microcatheter and guidewire-contact thrombolysis. The thrombolysis failed in 1 patient,and the blood flow was slow in 1 patient. Six patients had different degrees of cerebral infarction after procedure,and 1 died (peroperative Hunt-Hess grade Ⅳ). Three patients had vasospasm and they were improved after reducing blood vessel wall irritation and papaverine infusion. The introperative stent guidewire was broken and the stent in place was difficult in 1 case. The last coil packed difficultly during the procedure,and it protruded into the parent artery in 1 case. Two patients had non-aneurysmal hemorrhage after procedure. After conservative treatment,one left unilateral limb muscle strength decline and the other was stable after craniotomy,but leaving aphasia and hemiplegia. Conclusion When using the Enterprise stent-assisted embolization for complex aneurysms,grasping the indications strictly,strengthening the perioperative management and improving the operative skills may reduce or avoid the occurrence of complications.
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Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization.