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

被引:9
作者
Al-Ali, F. [1 ,3 ,4 ]
Cree, T. [2 ]
Duan, L.
Hall, S. [5 ]
Jefferson, A. [2 ]
Louis, S. [3 ,4 ]
Major, K. [3 ,4 ]
Smoker, S. [3 ,4 ]
Walker, S. [2 ]
机构
[1] Neurosurg Kalamazoo, Kalamazoo, MI 49048 USA
[2] Borgess Med Ctr, Borgess Res Inst, Kalamazoo, MI USA
[3] Borgess Med Ctr, Neurointervent Surg Serv, Kalamazoo, MI USA
[4] Borgess Med Ctr, Diagnost Serv, Kalamazoo, MI USA
[5] Michigan State Univ, Kalamazoo Ctr Med Studies, Kalamazoo, MI USA
关键词
STENT PLACEMENT; ATHEROSCLEROTIC STENOSES; WINGSPAN STENT; FOLLOW-UP; ANGIOPLASTY; SAFETY; EXPERIENCE;
D O I
10.3174/ajnr.A2670
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND AND PURPOSE: The WASID study established the risk of subsequent ischemic stroke at 1 year in subjects with symptomatic intracranial atherosclerotic stenosis (70%-99%) at 18%. The efficacy of different methods of endovascular revascularization in stroke prevention still has not been established. We compared the stroke rate in our registry at 1 year following intervention with the WASID results to identify which method, if any, provides the most benefit in stroke prevention. This result from the BMC-IRR follows a previously published article comparing stent placement and angioplasty outcomes. MATERIALS AND METHODS: We maintained a nonrandomized single-center single-operator registry of consecutive symptomatic patients who underwent endovascular intracranial revascularization. Data were collected prospectively and retrospectively and analyzed retrospectively. Patients were treated with angioplasty, BMS, or self-expanding WS. To make our data comparable with that in the WASID study, we selected patients with a single lesion of 50%-99% stenosis undergoing a single intervention. Data was collected on patients until symptom recurrence, repeat intervention, or 1 year postintervention, whichever occurred first. RESULTS: We found that 115 patients fit the inclusion criteria, with 38 angioplasty, 28 BMS, and 49 WS cases. For patients with 70%-99% stenosis, the overall probability of stroke at 1 year postintervention was 19.3%. The overall stroke probability per device, independent of clinical presentation, was 12.5% for angioplasty, 20.2% for BMS, and 24.1% for WS. CONCLUSIONS: Compared with the WASID data, angioplasty appears to have a lower stroke rate after 1 year than medical therapy alone. However, neither stern-placement arm compared favorably with the WASID results.
引用
收藏
页码:1227 / 1231
页数:5
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