Lower Perioperative Complications of Stent Implantation Assisted by Intracranial Support Catheter in the Treatment of ICAS: A Single-center Experience.

INTRODUCTION Stent implantation is an important treatment for intracranial atherosclerotic stenosis (ICAS). However, excessive perioperative complications can diminish patient benefits. The use of appropriate instruments can reduce complications. With the development of interventional materials, the intracranial support catheter is gradually being used in ICAS endovascular therapy.

METHOD This was a single-center retrospective analysis of 180 ICAS patients admitted to our institute between October 2021 and July 2024 to undergo stent implantation. The occurrence of stroke and death within 72 hours of the operation and the modified Rankin Scale (mRS) score at discharge were used to evaluate outcomes. We also measured stroke events (ischemic/ hemorrhagic), transient ischemic attack (TIA), all-cause mortality, and restenosis during the follow-up period.

RESULTS There were 87 (48.3%) cases that used an intracranial support catheter. In the group without the intracranial support catheter, there were 2 cases in which the stent failed to be delivered to the target vessel. Within 72 hours of the procedure, 3 minor strokes and 1 major stroke were reported in the group without the catheter, and 2 minor strokes occurred in the group using the intracranial support catheter. In the group without the catheter, two patients died from hemorrhagic stroke at discharge. Among 175 patients with a median follow-up time of 6 (3-24) months, 4 (2.3%) experienced TIA, and 4 (2.3%) experienced strokes. The in-stent stenosis rate of all patients who underwent re-examination was 8.6% (10/116). There was no significant difference in clinical and imaging follow-up results between the two groups.

DISCUSSION This study demonstrates that the use of an intracranial support catheter during endovascular therapy for ICAS significantly reduces periprocedural complication rates, with a notably lower risk of hemorrhage compared to findings from major prior clinical trials. This research also highlight the critical role of technical details and device selection in optimizing outcomes for ICAS intervention. However, further large-scale studies are needed to validate their generalizability and to investigate the impact of other technical factors on long-term functional outcomes for patients.

CONCLUSION Stent implantation assisted by an intracranial support catheter in the treatment of ICAS is safe and effective. The use of appropriate instruments, such as intracranial support catheters and microcatheters, can mitigate procedural complexity and reduce complications in cases with severe stenosis or tortuosity.