About this Research Topic
Intracranial endovascular use of Balloon and Stent has expanded significantly. This issue will highlight the use today with its advantages and limitations, focusing on most recent advancements. This discussion will also emphasize the improvements made towards understanding the disease process itself, no longer limiting the practice to devices alone.
Wide-necked intracranial aneurysms (IA) were originally thought to be either untreatable or, at the least, significantly challenging to treat by endovascular means due to the risk of coil protrusion into the parent vessel. Through recent advancements, balloon-remodeling technique (BRT) has been introduced. Additionally, stents specifically designed for intracranial use have progressively allowed these lesions to be treated endovascularly. BRT and stent-assisted coiling technique (SACT) were utilized for sidewall aneurysms, however both techniques have gained experience and technical development to treat bifurcated, complex-shaped, wide-neck aneurysms. Therefore, this article will review the inherent benefits and drawbacks to BRT as well as SACT.
The Chinese healthcare system has had significant improvements, however, this nation of 1.4 billion continues to faces challenges towards stroke treatment. Intracranial atherosclerosis is a prominent cause of stroke in various populations worldwide, including China, and has been noted to be the most common vascular lesion in stroke patients. Furthermore, symptomatic atherosclerotic stenosis of an intracranial artery results in a 14% risk of recurrent ischemia. This article will summarize the challenges of risk factor modification and secondary stroke prevention by defining optimal strategies.
After the publication of clinical trial SAMMPRIS, neurologists began to hesitate referring patients to interventionists. With intracranial artery stenosis being an important cause of stroke, we have designed a prospective study and a multicenter RCT to verify the effectiveness of percutaneous transluminal angioplasty and stenting (PTAS). This article will report the current situation, considerations for further clinical work in the field of intracranial artery stenosis in China and worldwide.
Angioplasty used in the setting of symptomatic intracranial stenosis has been performed for more than two decades. The technique has gradually become refined, randomized data is lacking to show the benefits compared to medical treatment. Nevertheless, medical treatment with severe symptomatic stenosis (>70%) continues to have high rates of stroke and death. This paper will review the history of angioplasty, current trends, and future uses of this treatment technique.
Despite impressive recanalization rates in ischemic stroke treatment, the clinical improvement rate has remained unchanged. In the last 20 years, less than 50% of patients demonstrated improvement resulting in the concept of the 50% barrier. This article will discuss the lack of optimal patient selection criteria and present the hypothesized capillary index score (CIS) on IMS I, II, III to surpass the 50% barrier.
Expansion of devices capable of mechanically interrupting clots found in occluded vessels has occurred in recent years. However, evidence is lacking to prove their advances over thrombolytic interventions that carry fewer risks. This article will review data from IMS III in order to answer this extremely fundamental question.
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