PT  - JOURNAL ARTICLE
AU  - V. Puetz
AU  - G. Gahn
AU  - U. Becker
AU  - D. Mucha
AU  - A. Mueller
AU  - N.U. Weir
AU  - B. Wiedemann
AU  - R. von Kummer
TI  - Endovascular Therapy of Symptomatic Intracranial Stenosis in Patients With Impaired Regional Cerebral Blood Flow or Failure of Medical Therapy
AID  - 10.3174/ajnr.A0829
DP  - 2008 Feb 01
TA  - American Journal of Neuroradiology
PG  - 273--280
VI  - 29
IP  - 2
4099  - http://www.ajnr.org/content/29/2/273.short
4100  - http://www.ajnr.org/content/29/2/273.full
SO  - Am. J. Neuroradiol.2008 Feb 01; 29
AB  - 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.