Long-term outcomes of resolute Onyx Zotarolimus-eluting stents for symptomatic intracranial stenosis: A multicenter propensity score-matched comparison with stenting versus aggressive medical management for preventing recurrent stroke in intracranial stenosis trial.
Omid Shoraka, Ramesh Grandhi, Samantha Miller, Joanna Roy, Vinay Jaikumar, Basel Musmar, Omar Tanweer, Jan-Karl Burkhardt, Pascal M Jabbour, Adnan H Siddiqui, Farhan Siddiq, Ameer E Hassan
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引用次数: 0
Abstract
BackgroundIntracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke. The Medtronic Resolute Onyx Zotarolimus-eluting stents (RO-ZES) are promising in preventing stroke recurrence compared with medical management (MM) and percutaneous angioplasty and stenting (PTAS) at both 30-day and one-year follow-ups. We evaluated long-term outcomes for patients treated with RO-ZES, PTAS, or MM.MethodsA retrospective multicenter study was conducted including patients who underwent RO-ZES stenting for symptomatic ICAD between March 2018 and May 2023, with follow-up through October 2024. Propensity score-matched control groups, representing MM and PTAS, were derived from the SAMMPRIS trial. Primary outcomes included recurrence rates of transient ischemic attack, stroke, intracerebral hemorrhage (ICH), and mortality. Time-to-event after intervention was evaluated.ResultsPatients who underwent stenting with RO-ZES and two propensity-matched cohorts from the SAMMPRIS trial who underwent MM and PTAS were included. Mean follow-up was 27.9 ± 17.0 months. The RO-ZES group demonstrated significantly fewer recurrent strokes (11.3%) compared with MM (27.0%) and PTAS (27.8%) (p = .003). The MM group experienced the lowest recurrence rate of ICH (0.9%) (p = .018). Multivariable regression revealed that RO-ZES experienced lower odds of recurrent strokes (OR = .40, 95% CI [0.17-0.92], p = .031) than PTAS throughout follow-up. Multivariable Cox regression demonstrated that RO-ZES stenting lowered the hazard of recurrent strokes compared with PTAS (hazard ratio = .36, 95% CI [0.16-0.80], p = .012).ConclusionTreatment of severe, symptomatic ICAD using RO-ZES was associated with lower odds of recurrent strokes compared with PTAS in this long-term follow-up study. Further prospective trials comparing MM with novel stent technologies are necessary.
背景:颅内动脉粥样硬化性疾病(ICAD)是缺血性脑卒中的主要原因。美敦力Resolute Onyx佐他莫司洗脱支架(RO-ZES)在30天和1年的随访中,与医疗管理(MM)和经皮血管成形术和支架植入(PTAS)相比,在预防卒中复发方面都有希望。方法回顾性多中心研究纳入2018年3月至2023年5月期间因症状性ICAD接受RO-ZES支架植入术的患者,随访至2024年10月。倾向评分匹配的对照组,代表MM和PTAS,来自SAMMPRIS试验。主要结局包括短暂性脑缺血发作、中风、脑出血(ICH)和死亡率的复发率。评估干预后到事件的时间。结果纳入了接受RO-ZES支架置入的患者和SAMMPRIS试验中接受MM和PTAS的两个倾向匹配的队列。平均随访27.9±17.0个月。与MM组(27.0%)和PTAS组(27.8%)相比,RO-ZES组复发性卒中发生率显著降低(11.3%)(p = 0.003)。MM组脑出血复发率最低(0.9%)(p = 0.018)。多变量回归显示,RO-ZES复发性卒中的几率较低(OR =。40, 95% CI [0.17-0.92], p = 0.031)。多变量Cox回归表明,与PTAS相比,RO-ZES支架置入降低了卒中复发的风险(风险比=。36, 95% CI [0.16-0.80], p = 0.012)。结论在这项长期随访研究中,与PTAS相比,使用RO-ZES治疗严重症状性ICAD的卒中复发几率较低。进一步的前瞻性试验比较MM与新型支架技术是必要的。
期刊介绍:
Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...