Abstract
BACKGROUND AND PURPOSE: The WASID study established the risk of subsequent ischemic stroke at 1 year in subjects with symptomatic intracranial atherosclerotic stenosis (70%–99%) at 18%. The efficacy of different methods of endovascular revascularization in stroke prevention still has not been established. We compared the stroke rate in our registry at 1 year following intervention with the WASID results to identify which method, if any, provides the most benefit in stroke prevention. This result from the BMC-IRR follows a previously published article comparing stent placement and angioplasty outcomes.
MATERIALS AND METHODS: We maintained a nonrandomized single-center single-operator registry of consecutive symptomatic patients who underwent endovascular intracranial revascularization. Data were collected prospectively and retrospectively and analyzed retrospectively. Patients were treated with angioplasty, BMS, or self-expanding WS. To make our data comparable with that in the WASID study, we selected patients with a single lesion of 50%–99% stenosis undergoing a single intervention. Data was collected on patients until symptom recurrence, repeat intervention, or 1 year postintervention, whichever occurred first.
RESULTS: We found that 115 patients fit the inclusion criteria, with 38 angioplasty, 28 BMS, and 49 WS cases. For patients with 70%–99% stenosis, the overall probability of stroke at 1 year postintervention was 19.3%. The overall stroke probability per device, independent of clinical presentation, was 12.5% for angioplasty, 20.2% for BMS, and 24.1% for WS.
CONCLUSIONS: Compared with the WASID data, angioplasty appears to have a lower stroke rate after 1 year than medical therapy alone. However, neither stent-placement arm compared favorably with the WASID results.
Footnotes
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- ACA
- anterior cerebral artery
- BA
- basilar artery
- BCC-IRR
- Borgess Medical Center Intracranial Revascularization Registry
- BMS
- balloon-mounted stent
- BMT
- best medical therapy
- CI
- confidence interval
- ICA
- internal carotid artery
- MCA
- middle cerebral artery
- mRS
- modified Rankin Scale
- SAMMPRIS
- Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis
- SSYLVIA
- Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries
- TIA
- transient ischemic attack
- VA
- vertebral artery
- WASID
- Warfarin-Aspirin Symptomatic Intracranial Disease
- WS
- Wingspan stent
- © 2011 American Society of Neuroradiology