doi: 10.3174/ajnr.A0829
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
American Journal of Neuroradiology 29:273-280, February 2008
© 2008 American Society of Neuroradiology
INTERVENTIONAL
Endovascular Therapy of Symptomatic Intracranial Stenosis in Patients With Impaired Regional Cerebral Blood Flow or Failure of Medical Therapy
a Department of Neurology, University of Technology, Dresden, Germany
b Department of Dresden Stroke Center, Neuroradiology, University of Technology, Dresden, Germany
c Department of Biostatistics, University of Technology, Dresden, Germany
d Department of Clinical Neurosciences, Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada
Please address correspondence to Volker Puetz, MD, Dresden Stroke Center, Department of Neurology, University of Technology, Fetscher Str 74, 01307 Dresden, Germany. E-mail: volker.puetz{at}neuro.med.tu-dresden.de
BACKGROUND AND PURPOSE:Symptomatic intracranial stenoses have a high risk for a recurrent stroke if treated medically. Although angioplasty and stent placement are proposed treatment options, data on longer-term outcome are limited.
Materials and METHODS:We analyzed all endovascular procedures on symptomatic intracranial stenosis at our institution from January 1998 to December 2005. We retrospectively assigned patients to group A (symptoms despite antithrombotic therapy) or group B (impaired regional cerebral blood flow [rCBF]). Primary outcome events were periprocedural major complications or recurrent ischemic strokes in the territory of the treated artery. We used the Kaplan-Meier method to calculate survival probabilities.
RESULTS:The procedural technical success rate was 92% (35/38) with periprocedural major complications in 4 cases (10.5%; group A [8.3%, 2/24], group B [14.3%, 2/14]). Median (range) follow-up for the 33 patients with technically successful procedures was 21 (0–72) months. Recurrent ischemic strokes occurred in 15% (3/20) of patients in group A and 0% (0/13) of patients in group B. Overall, there were 21% (7/33) primary outcome events (group A [25%, 5/20], group B [15%, 2/13]). There was a nonsignificant trend for better longer-term survival free of a major complication or recurrent stroke in patients with impaired rCBF compared with patients who were refractory to medical therapy treatment (Kaplan-Meier estimate 0.85 [SE 0.10] vs 0.72 [SE 0.11] at 2 years, respectively).
CONCLUSION:Interventional treatment of symptomatic intracranial stenosis carries significant risk for complications and recurrent stroke in high-risk patients. The observation that patients with impaired rCBF may have greater longer-term benefit than medically refractory deserves further study.