Intracranial angioplasty without stenting for symptomatic atherosclerotic stenosis: long-term follow-up

Abstract

Background and purpose: Angioplasty and stent placement have been reported for the treatment of intracranial stenosis. This study was undertaken to assess the efficacy and long-term clinical outcome of angioplasty without stent placement for patients with symptomatic intracranial stenosis.

Methods: A retrospective study was done to evaluate 36 patients with 37 symptomatic atherosclerotic intracranial stenosis who underwent primary balloon angioplasty. All patients had symptoms despite medical therapy. Thirty-four patients were available for follow-up ranging from 6 to 128 months. Mean follow-up was 52.9 months.

Results: Mean pretreatment stenosis was 84.2% before angioplasty and 43.3% after angioplasty. The periprocedural death and stroke rate was 8.3% (two deaths and one minor stroke). Two patients had strokes in the territory of angioplasty at 2 and 37 months after angioplasty. The annual stroke rate in the territory appropriate to the site of angioplasty was 3.36%, and for those patients with a residual stenosis of > or =50% it was 4.5%. Patients with iatrogenic dissection (n=11) did not have transient ischemic attacks or strokes after treatment.

Conclusion: Results of long-term follow-up suggest that intracranial angioplasty without stent placement reduces the risk of further stroke in symptomatic patients.

Fig 1.

Stroke-free Kaplan-Meier survival plot shows the percentage of patients alive without stroke in the territory appropriate to the site of angioplasty. Solid line represents the outcome for all treated patients; dashed line, stroke-free survival excluding strokes as procedural complications.

Fig 2.

Stroke-free Kaplan-Meier survival plot shows the percentage of patients alive without stroke after angioplasty. Solid line represents the outcome for all treated patients; dashed line, stroke-free survival excluding strokes as procedural complications.

Fig 3.

This 61-year-old woman had repeated vertebral basilar TIAs while receiving warfarin. A and B, Anterior pretreatment right vertebral artery angiograms (magnified image in D) show severe stenosis of the proximal basilar artery. C and D, Anterior right vertebral artery angiograms obtained immediately after angioplasty show improvement in the stenosis but continued moderate luminal narrowing. E and F, Angiograms obtained 2 months after angioplasty show mild improvement in the stenosis with remodeling. At last follow-up (60 months), the patient did not have additional symptoms.