Related Experiment Video
Updated: Jul 5, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Durability of endovascular therapy for symptomatic intracranial atherosclerosis
Mikael Mazighi1, Jay S Yadav, Alex Abou-Chebl
1Department of Neurology, Room 114, University of Louisville School of Medicine, 500 S. Preston St, Louisville, KY 40202, USA.
Insights
Intracranial stenting shows promise for reducing recurrent ischemia in patients with severe arterial stenosis when medical therapy fails. Stenting appears more durable than angioplasty alone, offering a better long-term outcome.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Intracranial angioplasty and stenting are options for symptomatic intracranial arterial stenosis.
- Long-term safety and efficacy data for these procedures were previously limited.
Purpose of the Study:
- To assess the long-term safety and clinical efficacy of intracranial angioplasty and stenting.
- To evaluate outcomes in patients with intracranial arterial stenosis refractory to medical management.
Main Methods:
- Retrospective analysis of patients treated with angioplasty and stenting for severe (>/=70%) intracranial atherostenoses.
- Collection of procedural data, 30-day outcomes, and clinical/radiographic follow-up up to 1 year and beyond.
Main Results:
- Technical success rate was 98.6% with significant stenosis reduction.
- 30-day death/stroke rate was 10.1%; median follow-up of 24 months showed a 5.8% stroke/TIA rate.
- Restenosis rate at 1 year was 15.9%, significantly lower with stenting (7.5%) compared to angioplasty alone (50%).
Conclusions:
- Intracranial stenting may offer a more durable solution than angioplasty alone for reducing recurrent ischemia.
- Stenting is a viable therapeutic option for carefully selected patients with symptomatic intracranial arterial stenosis.
- Factors like small vessel size and acute stroke intervention were associated with higher restenosis rates.
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.
