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BACKGROUND: Angioplasty and stenting using nitinol stents is a recognized treatment option for intracranial atherosclerosis.
OBJECTIVE: To identify procedure-related factors that may affect patient safety and technical outcome.
METHODS: In this prospective study of 57 consecutive patients, the primary end points were intra-procedural technical problems, peri-procedure morbidity and complications. Major peri-procedure complication was defined as all stroke or death at 30 days. Technical failure was defined as inability to complete the procedure due to technical or safety problems. Procedure failure was defined as a procedure outcome of technical failure or major peri-procedure complication. Secondary end points were procedure-related factors that may affect patient safety and technical outcome.
RESULTS: Procedure failure rate was 12.3% (7/57) (major peri-procedure complication rate 5.3% (3/57), technical failure rate 7% (4/57)). Initial failure in tracking of balloon or stent occurred in 20 patients, other technical problems occurred in 11 patients, including kinking or trapping of balloon catheter (2 cases), difficulty in unsheathing of stent (3 cases), forward migration of stent during deployment (4 cases), trapping of nose cone after stent deployment (1 case), fracture of delivery system (2 cases), and guidewire fracture (1 case). Unfavorable vascular morphology signified by presence of two or more reverse curves along the access path was found to associate with initial failure in tracking of instruments (OR=[infinity]), and occurrence of other technical problems (OR=25).
CONCLUSION: Procedure-related factors could be identified and lead to improvements in patient safety and technical outcome. Tortuous vascular morphology is a key factor to be overcome.
Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.
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