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Comparison of elective stenting of severe vs moderate intracranial atherosclerotic stenosis
1Department of Neurology and Interventional Neuroradiology, Beijing Tiantan Hospital, The Capital University of Medical Sciences, No. 6 Tiantan Xili, Beijing 100050, China. cjr.jiangweijian@vip.163.com
Insights
Symptomatic severe intracranial atherosclerotic stenosis showed no higher stroke risk than moderate stenosis after stenting. Stent failure predicted stroke in severe cases, suggesting potential benefits from successful stent placement.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Interventional Neuroradiology
Background:
- Intracranial atherosclerotic stenosis is a significant cause of stroke.
- Understanding stroke risk stratification after endovascular treatment is crucial for patient management.
Purpose of the Study:
- To compare subsequent stroke risk between severe and moderate intracranial atherosclerotic stenosis after elective stenting.
- To identify factors associated with post-procedural stroke.
Main Methods:
- Retrospective analysis of 220 symptomatic intracranial atherosclerotic stenoses (126 severe, 94 moderate) treated with balloon-expandable stents.
- Primary endpoints: lesion-related ischemic stroke and symptomatic intracranial hemorrhage.
- Follow-up duration averaged 26-27 months.
Main Results:
- No significant difference in cumulative stroke risk between severe and moderate stenosis groups at 1 and 2 years.
- Stent failure was the sole predictor of stroke in the severe stenosis group (HR 5.31).
- No specific factors predicted stroke in the moderate stenosis group.
Conclusions:
- Severe intracranial atherosclerotic stenosis does not confer a higher stroke risk than moderate stenosis post-stenting.
- Successful stent placement may benefit patients with severe stenosis.
- Randomized trials are needed to confirm the efficacy of stenting in severe cases.
Objective:
To test whether symptomatic severe intracranial atherosclerotic stenosis was associated with a higher subsequent stroke risk than moderate stenosis after elective angioplasty with a balloon-expandable stent and to explore which factors were associated with the subsequent stroke.
Methods:
Between September 2001 and June 2005, there were 220 symptomatic intracranial atherosclerotic stenoses in 213 patients undergoing elective stenting at our institute. Of these stenoses, 126 in 121 patients were > or =70% severe stenoses, and 94 in 92 patients were 50% to 69% moderate stenoses. Primary endpoints included lesion-related ischemic stroke, and symptomatic brain or subarachnoid hemorrhage.
Results:
Ten primary endpoint events occurred in the severe stenosis group (six within 30 days and four in mean follow-up of 26.0 months after 30 days), and seven occurred in the moderate stenosis group (four within 30 days and three in mean follow-up of 27.6 months after 30 days). There was no significant difference in cumulative probability of primary endpoints between the severe (7.2% at 1 year and 8.2% at 2 years) and moderate (5.3% at 1 year and 8.3% at 2 years) stenosis groups. No single factor was found to be associated with primary endpoints in the moderate stenosis group. Multivariable analysis revealed that stent failure was the only predictor of primary endpoints in the severe stenosis group (hazard ratio 5.31, 95% CI 1.35 to 20.91).
Conclusion:
Symptomatic severe intracranial atherosclerotic stenosis did not present a higher subsequent stroke risk than moderate stenosis after elective angioplasty with a balloon-expandable stent. Patients with severe stenosis may benefit from successful stent placement, and randomized trials are necessary to demonstrate this possible benefit.