Pharos neurovascular intracranial stent: Elective use for a symptomatic stenosis refractory to medical therapy |
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| Authors: | J Mocco MD MS Ziad Darkhabani MD Elad I. Levy MD |
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| Affiliation: | 1. Department of Neurosurgery, Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York;2. Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York;3. Conflict of interest: Dr. Levy receives research grant support, other research support (devices), and honoraria from Boston Scientific;4. has an ownership interest in Intratech Medical Ltd. and Micrus Endovascular;5. serves as a consultant to Cordis Neurovascular, Micrus Endovascular, ev3, and TheraSyn Sensors, Inc.;6. and receives fees for carotid stent training from Abbott Vascular and ev3. Dr. Levy now has an ownership interest in Mynx/Access Closure. Dr. Mocco has received a research grant from the Brain Aneurysm Foundation and has previously received a one‐time honorarium from Cordis. Dr. Darkhabani has no disclosures to report.;7. Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York;8. Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York |
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| Abstract: | The Warfarin‐Aspirin Symptomatic Intracranial Disease study investigators demonstrated that medically managed patients with symptomatic intracranial stenosis experience a 7–11% annual stroke risk. Early treatment efforts utilized balloon‐mounted coronary stents, which provided excellent angiographic results (postprocedure stenoses <10%), versus percutaneous transluminal angioplasty (PTA) alone (40%). However, the rigidity of balloon‐mounted coronary stents provided limited access to the tortuous cerebrovasculature. Self‐expanding stents became available for intracranial stenosis treatment in 2002. With increased flexibility, immediate results were encouraging (approximately 30% residual stenosis). However, midterm results have demonstrated disappointingly high rates of restenosis. To address these issues, the Pharos Neurovascular Stent System (Pharos, Micrus Endovascular, San Jose, CA) was developed. The Pharos is a balloon‐expandable stent mounted on a rapid‐exchange PTA catheter especially designed for intracranial endovascular applications. Utilizing the Pharos, we obtained an outstanding angiographic result (0% residual stenosis), with no associated morbidity. The patient was discharged home on postprocedure day 1 and remained symptom‐free, with no in‐stent stenosis, 3 months later. Our experience with the Pharos supports early literature suggesting that this stent may be a valuable treatment option for patients with medically refractory intracranial stenosis. © 2009 Wiley‐Liss, Inc. |
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| Keywords: | balloon‐expandable stent intracranial stenosis ischemic stroke Pharos stent |
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