Drug-eluting stent reduces stroke recurrence in intracranial atherosclerotic stenosis: JAMA

China: In a recent trial, drug-eluting stents (DES) were observed to minimize the risks of in-stent restenosis (ISR) and ischemic stroke recurrence in patients with symptomatic high-grade intracranial atherosclerotic stenosis (ICAS) compared to bare-metal stents (BMS). This study was conducted by Baixue Jia and the team, findings of which were published in the journal JAMA Neurology on 4th January 2022.

In patients treated with a conventional BMS, ISR is the most common cause of stroke recurrence following intracranial stenting. It is unknown if a DES may lower the danger of ISR in ICAS. Keeping the above point in mind, researchers conducted this study with the objective to see if a DES can lower the risk of ISR and stroke recurrence in individuals with symptomatic high-grade ICAS.

From April 27, 2015, to November 16, 2018, a prospective, multicenter, open-label randomized clinical study with blinded outcome assessment was done at 16 medical sites in China with a large volume of cerebral stenting. Patients with symptomatic high-grade ICAS were enrolled, randomized, and tracked for one year. From April 1 to May 22, 2021, intention-to-treat data were analyzed. In a 1:1 ratio, patients were randomly randomized to either DES (NOVA intracranial sirolimus-eluting stent system) or BMS (Apollo intracranial stent system) therapy. The primary effectiveness end goal was ISR one year after the surgery, defined as stenosis higher than 50% of the luminal diameter within or immediately next to (within 5 mm) the implanted stent. The key end objective for safety was any stroke or death within 30 days of the surgery.