Abstract
BACKGROUND AND PURPOSE: Intracranial atherosclerosis is especially prevalent in Asians, but intracranial stent placement and medical treatment for severe intracranial stenosis are controversial. Thus, we compared long-term outcomes of these 2 therapeutic approaches in an Asian population.
MATERIALS AND METHODS: Patients with angiographically proved severe (≥70%) symptomatic intracranial atherosclerosis, with or without stent placement, were retrospectively reviewed at a single center between 2002 and 2009, with adjustments for age, sex, vascular risk factors, degree of baseline stenosis, and baseline functional status.
RESULTS: Of the 114 patients followed from 3 to 36 months (mean, 17.3 months) after initial diagnosis, 53 received 56 stents in addition to medical treatment (stent-placement group), and 61 matched patients received only medical treatment (medical group). Total clinical events, including stroke, TIA, and vascular death, were 12 (22.6%) and 15 (24.6%) in the stent-placement and medical groups, respectively (P = .99). The stent-placement group had significantly better functional outcomes than the medical group (94.3% versus 78.7% for mRS scores of 0–3, P = .045). Most events in the stent-placement group occurred within the first week of the periprocedural period (17.0%) as minor embolic or perforator infarctions, and the rate of events decreased thereafter (5.7%, P = .07). Stent placement over the perforator-rich MCA and BA independently predicted periprocedural events on multivariate regression analysis. In the medical group, events increased in frequency (21.7%) and severity with time.
CONCLUSIONS: Although the total ischemic event rate was similar in the 2 groups during a 3-year follow-up, the stent-placement group had a more favorable functional outcome despite minor periprocedural strokes.
Abbreviations
- ACA
- anterior cerebral artery
- ADC
- apparent diffusion coefficient
- B
- balloon-mounted stent
- BA
- basilar artery
- BP
- blood pressure
- CS
- carotid siphon
- CVA
- cerebrovascular accident
- DSA
- digital subtraction angiography
- DWI
- diffusion-weighted imaging
- HbA1c
- glycated hemoglobin
- ICA
- internal carotid artery
- ICH
- intracerebral hemorrhage
- MCA
- middle cerebral artery
- mRS
- modified Rankin Scale
- NIH
- National Institutes of Health
- NS
- not significant
- SAH
- subarachnoid hemorrhage
- TIA
- transient ischemic attack
- VA
- vertebral artery
- VBJ
- vertebrobasilar junction
- WASID
- Warfarin-Aspirin Symptomatic Intracranial Disease
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