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(Stroke. 2009;40:2983.)
© 2009 American Heart Association, Inc.

Original Contributions

Outcome of Symptomatic Intracranial Atherosclerotic Disease

Edgar A. Samaniego, MD; Scott Hetzel, MS; Supriya Thirunarayanan, MD; Beverly Aagaard-Kienitz, MD; Aquilla S. Turk, DO Ross Levine, MD

From the Department of Neurology (E.A.S.), University of Wisconsin–Madison, Madison, Wisc; the Departments of Biostatistics and Medical Informatics (S.H.), Neurology (S.T.), and Neuroradiology (B.A.-K.), University of Wisconsin, University of Wisconsin Hospitals, Madison, Wisc; and the Department of Neurology and Radiology (R.L.), University of Wisconsin, University of Wisconsin Hospitals, Madison, Wisc.

Correspondence to Edgar A. Samaniego, MD, 701 Welch Road, Suite B 325, Palo Alto, CA 94304. E-mail esamanie{at}stanford.edu

Background and Purpose— Patients with intracranial atherosclerotic disease have a 3.6% to 22% annual risk of stroke. In this study, we sought to evaluate the natural history and prognosis of patients with symptomatic intracranial atherosclerotic disease who received medical therapy versus percutaneous transluminal angioplasty and stenting (PTAS) at our institution.

Methods— Charts of all patients with symptomatic intracranial atherosclerotic disease from July 2004 to September 2007 were reviewed and assessed for history of transient ischemic attack or stroke. Patients were either treated with "best medical therapy" (Medical Therapy Group) or PTAS plus antiplatelet agents (PTAS Group) and followed prospectively. A favorable outcome was defined as the absence of transient ischemic attacks, strokes, or vascular death; modified Rankin Scale of 3; and no endovascular reintervention of symptomatic in-stent restenosis.

Results— One hundred eleven patients fulfilled entry criteria, with 58 (52.3%) and 53 patients (47.7%) enrolled in the Medical Therapy and PTAS Groups, respectively. Thirty-eight patients of the Medical Therapy Group (65.5%) had a favorable outcome compared with 37 patients of the PTAS Group (69.8%). Combined ischemic end point data for the occurrence of transient ischemic attack, stroke, and vascular death was similar with 14 (24%) events in the Medical Therapy Group versus 15 (28.3%) events in the PTAS Group.

Conclusion— Overall, the combined ischemic end point was the same in the Medical Therapy and PTAS Groups.

Key Words: angioplasty and stenting • atherosclerosis • interventional neuroradiology • intracranial stenosis