This Article Full Text Full Text (PDF) All Versions of this Article: 39/6/1766    most recent STROKEAHA.107.500587v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mazighi, M. Articles by Abou-Chebl, A. Search for Related Content PubMed PubMed Citation Articles by Mazighi, M. Articles by Abou-Chebl, A. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Stroke Transient Ischemic Attack Related Collections Angioplasty and Stenting Related Article

(Stroke. 2008;39:1766.)
© 2008 American Heart Association, Inc.

Original Contributions

Durability of Endovascular Therapy for Symptomatic Intracranial Atherosclerosis

Mikael Mazighi, MD, PhD; Jay S. Yadav, MD Alex Abou-Chebl, MD

From the Interventional Neurology Unit (M.M., A.A.-C.), Cleveland Clinic, Ohio; and CardioMEMS, Inc (J.S.Y.), Atlanta, Ga.

Correspondence to Alex Abou-Chebl, MD, Department of Neurology, Room 114, University of Louisville School of Medicine, 500 S. Preston St, Louisville, KY 40202. E-mail a0abou03{at}louisville.edu

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.

Key Words: atherosclerosis • intracranial stenosis • stroke management

Related Article:

Symptomatic Intracranial Atherosclerotic Disease: What Is the Best Treatment Option?

Rishi Gupta
Stroke 2008 39: 1661-1662. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				E. A. Samaniego, S. Hetzel, S. Thirunarayanan, B. Aagaard-Kienitz, A. S. Turk, and R. Levine Outcome of Symptomatic Intracranial Atherosclerotic Disease Stroke, September 1, 2009; 40(9): 2983 - 2987. [Abstract] [Full Text] [PDF]

				T. N. Turan, C. P. Derdeyn, D. Fiorella, and M. I. Chimowitz Treatment of Atherosclerotic Intracranial Arterial Stenosis Stroke, June 1, 2009; 40(6): 2257 - 2261. [Full Text] [PDF]

				A. K. Wakhloo, M. J. Deleo III, and M. M. Brown Advances in Interventional Neuroradiology Stroke, May 1, 2009; 40(5): e305 - e312. [Abstract] [Full Text] [PDF]

				P. M. Meyers, H. C. Schumacher, R. T. Higashida, S. L. Barnwell, M. A. Creager, R. Gupta, C. G. McDougall, D. K. Pandey, D. Sacks, and L. R. Wechsler Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research Circulation, April 28, 2009; 119(16): 2235 - 2249. [Full Text] [PDF]

				C. Balucani, D. Leys, E. B. Ringelstein, M. Kaste, W. Hacke, and for the Executive Committee of the European Stroke Detection of Intracranial Atherosclerosis: Which Imaging Techniques Are Available in European Hospitals? Stroke, March 1, 2009; 40(3): 726 - 729. [Abstract] [Full Text] [PDF]

				R. Gupta Symptomatic Intracranial Atherosclerotic Disease: What Is the Best Treatment Option? Stroke, June 1, 2008; 39(6): 1661 - 1662. [Full Text] [PDF]