RT Journal Article
SR Electronic
T1 Stenting versus Medical Treatment for Severe Symptomatic Intracranial Stenosis
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 911
OP 916
DO 10.3174/ajnr.A2409
VO 32
IS 5
A1 Tang, C.-W.
A1 Chang, F.-C.
A1 Chern, C.-M.
A1 Lee, Y.-C.
A1 Hu, H.-H.
A1 Lee, I.-H.
YR 2011
UL http://www.ajnr.org/content/32/5/911.abstract
AB 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. ACAanterior cerebral arteryADCapparent diffusion coefficientBballoon-mounted stentBAbasilar arteryBPblood pressureCScarotid siphonCVAcerebrovascular accidentDSAdigital subtraction angiographyDWIdiffusion-weighted imagingHbA1cglycated hemoglobinICAinternal carotid arteryICHintracerebral hemorrhageMCAmiddle cerebral arterymRSmodified Rankin ScaleNIHNational Institutes of HealthNSnot significantSAHsubarachnoid hemorrhageTIAtransient ischemic attackVAvertebral arteryVBJvertebrobasilar junctionWASIDWarfarin-Aspirin Symptomatic Intracranial Disease