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Updated: Jan 30, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Long-Term Effects on Preventing Stroke after Endovascular Treatment or Bypass Surgery for Intracranial Arterial
Takuma Nakashima1, Takao Kojima2, Norikazu Hatano3
1Department of Neurosurgery, Tosei General Hospital, Aichi, Japan.
Insights
Surgical interventions like angioplasty, stenting, and bypass surgery show favorable long-term outcomes for intracranial arterial stenosis (ICAS) patients. These procedures offer better results than medical therapy alone for reducing stroke recurrence risk.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Surgery
Background:
- Intracranial arterial stenosis (ICAS) is a significant cause of ischemic stroke globally.
- Medical therapy for ICAS has limitations, with a high risk of stroke recurrence.
- Some patients may still benefit from surgical interventions for ICAS.
Purpose of the Study:
- To evaluate the long-term efficacy of surgical treatments for ICAS.
- To compare outcomes of percutaneous transluminal angioplasty/stenting (PTA/PTAS) and extracranial-intracranial (EC/IC) bypass surgery for ICAS patients.
Main Methods:
- Retrospective analysis of 55 ICAS patients treated between October 2005 and December 2016.
- Patients underwent PTA/PTAS or EC-IC bypass surgery.
- Primary outcome: adverse events beyond 30 days post-procedure; secondary outcome: long-term functional survival.
Main Results:
- Procedures included 21 PTA, 4 PTAS, and 34 EC-IC bypass surgeries.
- Median follow-up was 66 months.
- Overall adverse event rate was 10.2%; only 1.8% experienced ipsilateral disabling stroke beyond 30 days.
- Long-term functional independent survival rate was 83.6%.
Conclusions:
- Combined surgical interventions (PTA/PTAS and EC-IC bypass) demonstrate favorable long-term outcomes for ICAS patients.
- Surgical outcomes appear superior to previously reported medical therapy results for ICAS.
- Further multicenter studies are needed to confirm efficacy in reducing recurrent stroke in ICAS.
Background:
Intracranial arterial stenosis (ICAS) is an important cause of ischemic stroke worldwide due to its higher risk of recurrence with medical therapy. Although some large randomized studies failed to show the superiority of surgical treatment compared with medical therapy, the results of medical therapy are not sufficient. There are patients who still benefit from surgical treatment. This retrospective analysis aimed to evaluate the long-term efficacy of surgical therapy with percutaneous transluminal angioplasty and/or stenting (PTA/PTAS) or extracranial-intracranial (EC/IC) bypass surgery for patients with ICAS.
Methods:
Between October 2005 and December 2016, 55 ICAS patients were treated with PTA/PTAS or EC-IC bypass surgery. Their electronic medical records were retrospectively reviewed and analyzed. The primary outcome was all adverse events beyond 30 days after a revascularization procedure.
Results:
We performed 21 cases (35%) of PTA, 4 cases (7%) of PTAS, and 34 cases (58%) of EC-IC bypass surgery and the median follow-up duration was 66 months (range 1-144 months). The occurrence rate of the primary outcome was 10.2% and only 1 patient (1.8%) experienced ipsilateral disabling ischemic stroke beyond 30 days. The long-term functional independent survival rate was 83.6%.
Conclusions:
We demonstrated a long-term favorable outcome of combined surgical intervention for ICAS patients with PTA/PTAS and EC-IC bypass surgery, and the result was better than previously reported outcomes of medical therapy. Additional multicenter studies are required to draw firm conclusions on the efficacy of reduction of recurrent stroke in patients with ICAS.
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