STRICT-ICAS: Stenting for ischemic strokes secondary to medically refractory intracranial atherosclerotic disease

STRICT ICAS Abstract Intracranial atherosclerotic disease (ICAD) accounts for approximately 10% of ischemic strokes in the United States and is a major cause of recurrent strokes. Although three randomized controlled trials (RCT) have failed to show the benefit of endovascular treatment, there exists a subset of patients who experience recurrent strokes despite maximum medical therapy. These patients may benefit from Percutaneous Angioplasty and Stenting (PTAS), especially when selecting flow-related stroke subtypes rather than perforator or embolic strokes or patients with recurrent transient ischemic attacks. A follow- up post-market surveillance study mandated by the FDA to evaluate peri-procedural safety of the Wingspan Stent (Stryker, Kalamazoo, MI) demonstrated reduced perioperative stroke and death rates, further suggesting that patients could benefit from PTAS. The experience of neurointerventionalists and proper patient selection were the main reported factors for a lower periprocedural stroke and death rate in the WEAVE trial in comparison to the SAMMPRIS trial. The practice pattern of endovascular treatment for medically refractory ICAD has been evolving since the publication of the WEAVE trial with an increasing off-label utilization of balloon-mounted coronary stents or other self-expanding stents. Since the publication of the three negative RCTs, there has been a lack of prospective data regarding current endovascular practice patterns for ICAD. There is likely variation in patient selection, timing of intervention, and devices used. Analyzing these may provide insight into optimal practices for the endovascular treatment of ICAD and the design of future trials. Study purpose: Establish a prospective multicenter registry of the patients undergoing intracranial stenting for ischemic strokes caused by medically refractory ICAD to evaluate current practice pattern, periprocedural and delayed outcomes.