Abstract
Background
This study aimed to evaluate the safety profile and limitations of Neuroform EZ stenting in patients with hypoperfusion-related symptomatic intracranial atherosclerotic stenosis (ICAS), focusing on lesion morphology and risk stratification to identify patient subgroups that require stricter preoperative selection criteria.Methods
We conducted a retrospective analysis of consecutive patients with hypoperfusion-related symptomatic ICAS who underwent Neuroform EZ stent placement at our institution between January 2020 and October 2023. The primary endpoint was the occurrence of any stroke or death within 30 days post-procedure. Secondary endpoints included technical success rate, incidence of ischemic stroke in the target artery territory from 30 days to 6 months post-procedure, and in-stent restenosis (ISR) rate during follow-up.Results
A total of 64 patients (64 lesions) were included, all treated with Neuroform EZ stents. The technical success rate was 98.4%. The 30-day stroke or death rate was 6.2% (4/64). The incidence of ischemic stroke in the target artery territory from 30 days to 6 months post-procedure was 1.6% (1/64). During a mean follow-up of 10.4 ± 6.5 months, the ISR rate was 13.7% (7/51). Subgroup analysis revealed that the 30-day perioperative complication rate was significantly higher in patients with Mori type C lesions (25.0%, 4/16) than in those with Mori type A (0%, 0/16) or type B lesions (0%, 0/32) (Fisher's exact test, P = 0.002). Additionally, the ISR rate was significantly higher in Mori type C lesions (46.2%, 6/13) compared with Mori type A (0%, 0/14) or type B lesions (4.2%, 1/42) (Fisher's exact test, P Conclusion
Neuroform EZ stenting may be a reasonable option for carefully selected patients with hypoperfusion-related ICAS and Mori type A/B lesions. However, its use in Mori type C lesions carries substantial periprocedural and restenosis risks and must be approached with extreme caution. These findings provide safety-focused risk stratification but require external validation, and do not prove that Neuroform EZ stenting is superior to standard medical therapy or other stent devices. Further controlled studies are required to validate these observations.