Stent-assisted angioplasty of intracranial vertebrobasilar atherosclerosis: midterm analysis of clinical and radiologic predictors of neurological morbidity and mortality

Abstract

Background and purpose: Initial reports of stent-assisted angioplasty for intracranial vertebrobasilar atherosclerosis suggest this is a feasible treatment, but there have been little data regarding predictors of success or failure. We analyzed a series of patients for independent predictors of neurologic morbidity and mortality.

Methods: Patient charts and angiograms from 39 patients who underwent intracranial angioplasty and stent placement of vertebrobasilar stenoses were retrospectively reviewed to obtain clinical and detailed angiographic data on potential predictors of neurologic morbidity and mortality. Univariate analyses of these predictors were performed with either Fisher's exact test or simple logistic regression. Multivariate analysis was subsequently performed on the statistically significant predictors.

Results: Complete clinical data were obtained for 39 patients, and angiographic review was possible for 35 of them. Angiography revealed severe intracranial vertebral (n = 18), basilar (n = 15), or basilar and vertebral (n = 2) stenoses. Two patients (5.1%) died in the periprocedural period, nine patients (23.1%) had neurologic complications, and one patient (2.6%) had transient neurologic symptoms. Univariate analysis revealed female sex, diabetes, and failure of coumadin or heparin therapy were associated with neurologic morbidity, whereas female sex, Mori B lesion, and length-to-stenosis ratio were associated with mortality. The presence of diabetes was the only independent predictor of neurologic morbidity and mortality.

Conclusion: Because of the limited number of patients available for analysis, the only independent predictor of neurologic morbidity and mortality was diabetes, but several other predictors showed trends that deserve further review in future series.