Durability of endovascular therapy for symptomatic intracranial atherosclerosis

Stroke. 2008 Jun;39(6):1766-9. doi: 10.1161/STROKEAHA.107.500587. Epub 2008 Apr 17.

Abstract

Background and purpose: Intracranial angioplasty and stenting are therapeutic options for patients with symptomatic intracranial arterial stenoses intractable to medical therapy. However, the long-term safety and clinical efficacy of these techniques are unknown. We sought to assess the long-term outcome and efficacy of these techniques.

Methods: Procedural data and 30-day outcomes were collected from patients treated with coronary balloons and stents for >/=70% atherostenoses. Clinical and radiographic follow-up data were obtained at 30 days, 6 months, 12 months, and yearly thereafter.

Results: Fifty-three patients (median age, 67 years; interquartile range [IQR], 58.75 to 75 years) with 69 arterial lesions were treated during a 7-year period. The technical success rate was 98.6% (68/69), with a reduction of the median percent stenosis from 85% (IQR, 70% to 95%) to 0% (IQR, 0% to 26%). In 76.8% (53/69) of the procedures, a stent was implanted. The 30-day death/stroke rate was 10.1% (7/69) with 1 death, and within a median follow-up of 24 months (IQR, 10.25 to 36.5 months), the transient ischemic attack or stroke rate reached 5.8% (4/69). Restenosis rate at 1 year was 15.9% (11/69) and was symptomatic in 18.2% (2/11). The restenosis rate was 50% for angioplasty (8/16) and 7.5% (4/53) for stenting (hazard ratio=5.02; 95% CI, 1.22 to 20.68). Factors associated with restenosis were vessel size <2.5 mm (hazard ratio=4.78; 95% CI, 1.35 to 16.93) and interventions performed in the setting of an acute stroke (hazard ratio=6.36; 95% CI, 1.78 to 22.56).

Conclusions: Intracranial stenting may reduce the rate of recurrent ischemia in patients in whom medical therapy is unsuccessful and is probably more durable than angioplasty alone.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angioplasty, Balloon / instrumentation
  • Angioplasty, Balloon / methods
  • Angioplasty, Balloon / statistics & numerical data*
  • Brain Ischemia / physiopathology
  • Brain Ischemia / prevention & control
  • Brain Ischemia / therapy*
  • Cerebral Arteries / pathology
  • Cerebral Arteries / physiopathology
  • Female
  • Follow-Up Studies
  • Graft Occlusion, Vascular
  • Humans
  • Intracranial Arteriosclerosis / physiopathology
  • Intracranial Arteriosclerosis / therapy*
  • Ischemic Attack, Transient / physiopathology
  • Ischemic Attack, Transient / prevention & control
  • Ischemic Attack, Transient / therapy*
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use
  • Secondary Prevention
  • Stents / statistics & numerical data*
  • Stroke / physiopathology
  • Stroke / prevention & control
  • Stroke / therapy*
  • Time
  • Treatment Outcome

Substances

  • Platelet Aggregation Inhibitors