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Research ArticleNeurointerventionE

How Effective Is Endovascular Intracranial Revascularization in Stroke Prevention? Results from Borgess Medical Center Intracranial Revascularization Registry

F. Al-Ali, T. Cree, L. Duan, S. Hall, A. Jefferson, S. Louis, K. Major, S. Smoker and S. Walker
American Journal of Neuroradiology August 2011, 32 (7) 1227-1231; DOI: https://doi.org/10.3174/ajnr.A2670
F. Al-Ali
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T. Cree
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L. Duan
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S. Hall
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A. Jefferson
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S. Louis
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K. Major
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S. Smoker
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S. Walker
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  • Article
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Article Figures & Data

Tables

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    Table 1:

    Patient demographics and medical history

    No. of Patients with Data (%)aStroke in Territory (%) (n = 20)No Stroke in Territory (%) (n = 95)
    Age (yr)11564.05 ± 11.866.1 ± 12.9
    Sex
        Male68 (59)8 (12)60 (88)
        Female47 (41)12 (26)35 (74)
    Diabetes
        No60 (57)9 (15)51 (85)
        Yes46 (43)8 (17)38 (83)
    Hypertension
        No13 (12)1 (8)12 (92)
        Yes96 (88)19 (20)77 (80)
    Hyperlipidemia
        No31 (28)7 (23)24 (77)
        Yes78 (72)12 (15)66 (85)
    Ischemic stroke
        No49 (57)9 (18)40 (82)
        Yes37 (43)5 (14)32 (86)
    Heart disease
        No72 (69)15 (21)57 (79)
        Yes32 (31)4 (13)28 (88)
    Smoking
        No41 (63)6 (15)35 (85)
        Yes24 (37)4 (17)20 (83)
    • a Data are not available for all patients.

    • View popup
    Table 2:

    Patient presentation, intervention, and lesion characteristics

    No. of Patients with Data (%)aStroke inTerritory (%) (n = 20)No Stroke in Territory (%) (n = 95)
    Days from last symptom to treatment11532.8 ± 34.366.2 ± 124.2
    Treatment
        Angioplasty38 (33)4 (11)34 (89)
        BMS28 (24)5 (18)23 (82)
        WS49 (43)11 (22)38 (78)
    Presenting mRS at time of intervention115 (100)1.8 ± 1.31.4 ± 1.1
    % Stenosis before primary procedure
        <70%7 (6)1 (14)6 (86)
        ≥70%107 (94)19 (18)88 (82)
    Qualifying event
        TIA39 (34)8 (21)31 (79)
        Minor stroke28 (25)7 (25)21 (75)
        Major stroke46 (41)5 (11)41 (89)
    Lesion location
        ICA/VA46 (40)6 (13)40 (87)
        MCA/BA68 (60)14 (21)54 (79)
    Lesion morphology
        Smooth80 (72)12 (15)68 (85)
        Irregular31 (28)8 (26)23 (74)
        Concentric58 (52)9 (16)49 (84)
        Eccentric53 (48)11 (21)42 (79)
        Ulceration17 (15)4 (24)13 (76)
        No ulceration94 (85)16 (17)78 (83)
    Lesion length
        Short (<5 mm)44 (40)5 (11)39 (89)
        Moderate (5–10 mm)17 (15)5 (29)12 (71)
        Long (>10 mm)50 (45)10 (20)40 (80)
        Activated clotting time at stent deployment85 (74)216.2 ± 32.5217.0 ± 24.9
        Time from 1st visit until event (day)115 (100)25.9 ± 63.3269.5 ± 133.2
    • a Data are not available for all patients.

    • View popup
    Table 3:

    Probability of stroke based on symptom recurrence or repeat intervention at 30 days and 1 year

    30 Days1 Year
    Significant P Value95% Hazard Ratio CIsSignificant P Value95% Hazard Ratio CIs
    Stenting vs angioplasty.0310.010–0.799.0520.041–1.016
    Female vs male.0620.940–12.280.1330.776–6.838
    Minimal vs maximum no. of days from symptom onset to treatment.0660.399–1.030.2180.527–1.157
    Smooth vs irregular lesion.0490.085–0.995.0740.128–1.099
    Concentric vs eccentric lesions.1210.121–1.278.2870.200–1.611
    Medium/long vs short lesions.1450.709–10.442.1930.680–6.756
    • View popup
    Table 4:

    Probability of stroke in the territory based on presenting severity of stenosis and qualifying eventa

    Qualifying EventStenosis 50%–99%Stenosis 50%–69%Stenosis 70%–99%
    BMC-IRRBMC-IRRWASIDBMC-IRRWASID
    TIA (1 yr)0.11 (0.05–0.25)00.03 (0.01–0.06)0.12 (0.05–0.26)0.14 (0.06–0.22)
    Stroke (1 yr)0.25 (0.16–0.38)0.20 (0.03–0.80)0.08 (0.04–0.12)0.26 (0.16–0.40)0.23 (0.15–0.30)
    • a Data are presented as mean probability (95% CI).

    • View popup
    Table 5:

    Probability of stroke in the territory based on presenting severity of stenosis and qualifying event: TIA, minor stroke, or major strokea

    Stenosis 50%–69%Stenosis 70%–99%
    TIA
        1 year00.116 (0.050–0.256)
    Minor stroke
        1 year1.0000.212 (0.106–0.400)
    Major stroke
        1 year00.322 (0.166–0.566)
    • a Data are presented as mean probability (95% CI).

    • View popup
    Table 6:

    Probability of stroke within 1 year in the territory based on intervention typea

    Stenosis 50%–99%Stenosis 70%–99%
    All interventions: BMC-IRR0.193 (0.128–0.285)0.193 (0.127–0.288)
    Angioplasty0.125 (0.048–0.301)0.125 (0.048–0.301)
    BMS0.194 (0.085–0.409)0.202 (0.089–0.424)
    WS0.241 (0.140–0.395)0.241 (0.137–0.404)
    • a Data are presented as mean probability (95% CI).

    • View popup
    Table 7:

    Probability of stroke within 1 year in the territory based on location and intervention type for 50%–99% stenosisa

    Nonperforator Vessels (ICA/VA)Perforator Vessels (BA/MCA)
    Angioplasty0.091 (0.013–0.492)0.144 (0.049–0.386)
    BMS0.134 (0.034–0.448)0.333 (0.122–0.718)
    WS0.226 (0.079–0.551)0.246 (0.130–0.434)
    • a Data are presented as mean probability (95% CI).

    • View popup
    Table 8:

    Lesion distribution

    InterventionLesion LocationCountProportion (%)
    Angioplasty (n = 37)MCA2362.2
    ICA718.9
    BA38.1
    VA410.8
    BMS (n = 29)MCA00.0
    ICA931.0
    BA931.0
    VA1137.9
    WS (n = 49)MCA2450.0
    ICA1020.8
    BA1020.8
    VA48.3
    • View popup
    Table 9:

    Comparison of lesion distribution: BMC-IRR versus WASID

    Lesion LocationBMC-IRRWASID
    MCA41.232.5
    ICA22.821.6
    BA19.319.4
    VA16.720.3
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American Journal of Neuroradiology: 32 (7)
American Journal of Neuroradiology
Vol. 32, Issue 7
1 Aug 2011
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F. Al-Ali, T. Cree, L. Duan, S. Hall, A. Jefferson, S. Louis, K. Major, S. Smoker, S. Walker
How Effective Is Endovascular Intracranial Revascularization in Stroke Prevention? Results from Borgess Medical Center Intracranial Revascularization Registry
American Journal of Neuroradiology Aug 2011, 32 (7) 1227-1231; DOI: 10.3174/ajnr.A2670

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How Effective Is Endovascular Intracranial Revascularization in Stroke Prevention? Results from Borgess Medical Center Intracranial Revascularization Registry
F. Al-Ali, T. Cree, L. Duan, S. Hall, A. Jefferson, S. Louis, K. Major, S. Smoker, S. Walker
American Journal of Neuroradiology Aug 2011, 32 (7) 1227-1231; DOI: 10.3174/ajnr.A2670
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