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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:1882-1892, October 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

Intracranial Angioplasty and Stenting: Long-Term Results from a Single Center

J.C. Wojak^a,b, D.C. Dunlap^c, K.R. Hargrave^c, L.A. DeAlvare^c, H.S. Culbertson^d and J.J. Connors, III^e

^a Department of Radiology, Our Lady of Lourdes Regional Medical Center, Lafayette, La
^b Department of Radiology, Louisiana State University School of Medicine, New Orleans, La
^c Neurology Service, Our Lady of Lourdes Regional Medical Center, Lafayette, La
^d Alexandria Neurosurgical Clinic, Alexandria, La
^e Department of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami Baptist Hospital, Miami, Fla

Please address correspondence to: Joan C. Wojak, MD, Our Lady of Lourdes Regional Medical Center, 611 Saint Landry St, Lafayette, LA 70506; e-mail: woji{at}msn.com

BACKGROUND AND PURPOSE: Large-vessel intracranial atherosclerotic stenosis carries a proved stroke risk of 8%–22% per year with "best medical therapy." The long-term clinical neurologic and angiographic outcomes of angioplasty and/or stent placement for intracranial atherosclerosis in a consecutive series of patients are presented.

METHODS: The demographics, procedural details, procedural outcome, and long-term neurologic follow-up in 60 consecutive patients with 71 lesions, undergoing a total of 84 procedures, were analyzed.

RESULTS: Angioplasty alone was performed in 62 procedures; 22 procedures involved stent placement. The periprocedural stroke+death rate was 4.8%. The overall complication-free success rate was 90.5%. Restenosis occurred in 23 lesions at a mean of 4.6 months; 13 were re-treated without complication. There were 4 strokes and 4 non-neurologic deaths during 224 patient-years of follow-up. The annualized stroke rate was 1.8%, and the annualized stroke+all-cause death rate was 3.0%.

CONCLUSIONS: The stroke and death rates in this consecutive series of patients with severe intracranial atherosclerotic stenosis treated with optimal endovascular therapy are considerably less than those associated with the natural history of intracranial atherosclerosis treated with maximal medical therapy. Intracranial angioplasty with conditional stent placement is technically feasible and clinically effective with a substantial reduction in long-term stroke and death.

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