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(Stroke. 2006;37:1016.)
© 2006 American Heart Association, Inc.

Original Contributions

Angioplasty for Symptomatic Intracranial Stenosis

Clinical Outcome

Michael P. Marks, MD; Joan C. Wojak, MD; Firas Al-Ali, MD; Mahesh Jayaraman, MD; Mary L. Marcellus, RN; John J. Connors, MD Huy M. Do, MD

From the Department of Radiology (M.P.M., M.J., M.L.M., H.M.D.), Stanford University Medical Center, California; Our Lady of Lourdes Regional Medical Center (J.C.W.), Lafayette, La; Borgess Medical Center (F.A.-A.), Kalamazoo, Mich; and St Josephs Hospital (J.J.C.), Tampa, Fla.

Correspondence to Michael P. Marks, MD, Stanford University Medical Center, Department of Radiology, Room S-047, 300 Pasteur Dr, Stanford CA 94305-5105. E-mail mmarks{at}stanford.edu

Background and Purpose— Medical treatment of symptomatic intracranial stenosis carries a high risk of stroke. This study was done to evaluate the clinical and angiographic outcomes after intracranial angioplasty for this disease.

Methods— A total of 120 patients with 124 intracranial stenoses were treated by primary angioplasty. All patients had neurologic symptoms (stroke or transient ischemic attack) attributable to intracranial stenoses 50%. Angiograms were evaluated before and after angioplasty for the degree of stenosis.

Results— Pretreatment stenoses varied from 50% to 95% (mean 82.2±10.2). Post-treatment stenoses varied from 0% to 90% (mean 36.0±20.1). There were 3 strokes and 4 deaths (all neurological) within 30 days of the procedure, giving a combined periprocedural stroke and death rate of 5.8%. A total of 116 patients (96.7%) were available for a mean follow-up time of 42.3 months. There were 6 patients who had a stroke in the territory of treatment and 5 additional patients with stroke in other territories. Ten deaths occurred during the follow-up period, none of which were neurological. Including the periprocedural stroke and deaths, this yielded an annual stroke rate of 3.2% in the territory of treatment and a 4.4% annual rate for all strokes.

Conclusion— Intracranial angioplasty can be performed with a high degree of technical success and a low risk of complications. Long-term clinical follow-up of intracranial angioplasty patients demonstrates a risk of future strokes that compares favorably to patients receiving medical therapy.

Key Words: angioplasty • arteriosclerosis • basilar artery • carotid arteries • middle cerebral artery

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