• Cerebrovascular Disease
• Interventional Radiology Clinical Trials
• Interventional Techniques & Devices

Angioplasty appears to be safer than stenting for endovascular revascularization in patients with intracranial atherosclerosis and results in a lower stroke risk.

Results of the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID; NCT00004728) study suggested that patients with stroke as their qualifying event and a 70% to 99% stenosed lesion had a 1-year stroke rate of 22.5%. The objective of a study presented by Firas Al-Ali, MD, Borgess Medical Center, Kalamazoo, MI, was to compare the safety and efficacy of endovascular revascularization for intracranial atherosclerosis to determine if it is possible to reduce the risk of stroke that was seen in the WASID study. This was a retrospective analysis of prospectively collected data from a single center. Data collection included success rate, complication rate within 30 days, restenosis rate, and stroke rate at 1 year postintervention.

Data were available for 138 patients with >70% stenosis. Of these, 50 patients underwent 59 primary angioplasties on a total of 58 lesions. A total of 88 patients with 98 lesions underwent 99 primary stenting procedures. Wingspan Stent (WSS”) was used for 55 patients, and a balloon-mounted stent (BMS) was used in 33 patients. Three patients had both types of stents for different vessels.

The success rate in the angioplasty group was 94.9%. Three of the 59 primary angioplasty procedures required immediate stenting for a large dissection, and 3 were associated with complications (2 minor strokes and 1 groin infection) within the first 30 days. Imaging follow-up was available for 41/58 lesions. Overall, 43% of the lesions required a second intervention or had a vascular occlusion/near-occlusion. Clinical follow-up (mean 31.7 months) was available for 46 patients. There were 2 strokes—1 in the same vascular territory and 1 in a different vascular territory.

The success rate for primary stenting was 96.6% for the WSS group and 97.4% for the BMS group. Within the BMS group there were 6 periprocedural complications, 4 of which were strokes. Of these, there were 3 in the basal artery that resulted in significant deficit (mRS 2, 3, and 4). One patient had a vessel perforation. Imaging follow-up was available for 28 patients/vessels. Restenosis (<40%) occurred in 1 patient. Clinical follow-up (mean 17.6 months) was available for all 33 BMS patients. There were 3 strokes, 2 of which resulted in death, felt to be due to in-stent thrombosis. The mortality rate at 1 year for the BMS group was 9.1%.

Within the WSS group, there were 12 periprocedural complications; none was fatal. Two were subarachnoid hemorrhage. Of these, 1 (distal microwire perforation) was significant, with an mRS of 3 at the 1-year follow-up. The other was minimal and related to a microtear from the angioplasty balloon, which was well controlled by stent placement. One patient presented with intraparenchymal hematoma 3 days after stenting but was asymptomatic at 2 weeks. There were 8 ischemic strokes, of which 2 were significant and required inpatient rehabilitation. Six were minor, wherein the patient returned to normal in <1 week. Imaging follow-up was available for 42/59 vessels. Overall, 28.4% of patients had occlusion or needed reangioplasty. Clinical follow-up (mean 6.7 months) was available for 40 patients. There were a total of 3 ischemic strokes within 1 year (7.5%). Two patients had minor strokes that resolved completely. One patient had a major (mRS 4) stroke.

• © 2009 MD Conference Express