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Intracranial angioplasty and stenting: long-term results from a single center
J C Wojak1, D C Dunlap, K R Hargrave
1Department of Radiology, Our Lady of Lourdes Regional Medical Center, Lafayette, LA 70506, USA. woji@msn.com
Insights
Endovascular therapy, including angioplasty and stenting, significantly reduces stroke and death rates in patients with severe intracranial atherosclerotic stenosis compared to medical management.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Large-vessel intracranial atherosclerotic stenosis poses a significant stroke risk (8%-22% annually) with best medical therapy.
- Optimal medical therapy for intracranial atherosclerosis has limitations in preventing recurrent strokes.
Purpose of the Study:
- To evaluate the long-term clinical, neurologic, and angiographic outcomes of endovascular treatment for intracranial atherosclerotic stenosis.
- To compare the efficacy of angioplasty and/or stenting against the natural history of the disease.
Main Methods:
- Analysis of 60 consecutive patients with 71 lesions undergoing 84 procedures (angioplasty alone or with stenting).
- Assessment of demographics, procedural details, outcomes, and long-term neurologic follow-up.
- Data collected over 224 patient-years.
Main Results:
- Periprocedural stroke and death rate was 4.8% with an overall complication-free success rate of 90.5%.
- Restenosis occurred in 23 lesions, with 13 re-treated successfully.
- Annualized stroke rate was 1.8%, and annualized stroke plus all-cause death rate was 3.0%.
Conclusions:
- Endovascular therapy, including angioplasty with conditional stenting, is technically feasible and clinically effective for severe intracranial atherosclerotic stenosis.
- This approach offers a substantial reduction in long-term stroke and death rates compared to maximal medical therapy.
- The study demonstrates favorable outcomes for endovascular treatment in this high-risk patient group.
Background And Purpose:
Large-vessel intracranial atherosclerotic stenosis carries a proved stroke risk of 8%-22% per year with "best medical therapy." The long-term clinical neurologic and angiographic outcomes of angioplasty and/or stent placement for intracranial atherosclerosis in a consecutive series of patients are presented.
Methods:
The demographics, procedural details, procedural outcome, and long-term neurologic follow-up in 60 consecutive patients with 71 lesions, undergoing a total of 84 procedures, were analyzed.
Results:
Angioplasty alone was performed in 62 procedures; 22 procedures involved stent placement. The periprocedural stroke+death rate was 4.8%. The overall complication-free success rate was 90.5%. Restenosis occurred in 23 lesions at a mean of 4.6 months; 13 were re-treated without complication. There were 4 strokes and 4 non-neurologic deaths during 224 patient-years of follow-up. The annualized stroke rate was 1.8%, and the annualized stroke+all-cause death rate was 3.0%.
Conclusions:
The stroke and death rates in this consecutive series of patients with severe intracranial atherosclerotic stenosis treated with optimal endovascular therapy are considerably less than those associated with the natural history of intracranial atherosclerosis treated with maximal medical therapy. Intracranial angioplasty with conditional stent placement is technically feasible and clinically effective with a substantial reduction in long-term stroke and death.