title: Endovascular therapy of symptomatic intracranial stenosis in patients with impaired regional cerebral blood flow or failure of medical therapy.
abstract: OBJECTIVE
  Symptomatic intracranial stenoses have a high risk for a recurrent stroke if treated medically. Although angioplasty and stent placement are proposed treatment options, data on longer-term outcome are limited.
  
  
  METHODS
  We analyzed all endovascular procedures on symptomatic intracranial stenosis at our institution from January 1998 to December 2005. We retrospectively assigned patients to group A (symptoms despite antithrombotic therapy) or group B (impaired regional cerebral blood flow [rCBF]). Primary outcome events were periprocedural major complications or recurrent ischemic strokes in the territory of the treated artery. We used the Kaplan-Meier method to calculate survival probabilities.
  
  
  RESULTS
  The procedural technical success rate was 92% (35/38) with periprocedural major complications in 4 cases (10.5%; group A [8.3%, 2/24], group B [14.3%, 2/14]). Median (range) follow-up for the 33 patients with technically successful procedures was 21 (0-72) months. Recurrent ischemic strokes occurred in 15% (3/20) of patients in group A and 0% (0/13) of patients in group B. Overall, there were 21% (7/33) primary outcome events (group A [25%, 5/20], group B [15%, 2/13]). There was a nonsignificant trend for better longer-term survival free of a major complication or recurrent stroke in patients with impaired rCBF compared with patients who were refractory to medical therapy treatment (Kaplan-Meier estimate 0.85 [SE 0.10] vs 0.72 [SE 0.11] at 2 years, respectively).
  
  
  CONCLUSIONS
  Interventional treatment of symptomatic intracranial stenosis carries significant risk for complications and recurrent stroke in high-risk patients. The observation that patients with impaired rCBF may have greater longer-term benefit than medically refractory deserves further study.
authors.affiliation: Department of Neurology, Dresden Stroke Center,University of Technology, Dresden, Germany. volker.puetz@neuro.med.tu-dresden.de
authors.forename: V
authors.initials: V
authors.lastname: Puetz
authors.forename: G
authors.initials: G
authors.lastname: Gahn
authors.forename: U
authors.initials: U
authors.lastname: Becker
authors.forename: D
authors.initials: D
authors.lastname: Mucha
authors.forename: A
authors.initials: A
authors.lastname: Mueller
authors.forename: N U
authors.initials: NU
authors.lastname: Weir
authors.forename: B
authors.initials: B
authors.lastname: Wiedemann
authors.forename: R
authors.initials: R
authors.lastname: von Kummer
mesh_terms: D000800:Angioplasty, Balloon / Q000401:mortality*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D002545:Brain Ischemia / Q000401:mortality* / Q000517:prevention & control*; D016893:Carotid Stenosis / Q000401:mortality* / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D017211:Treatment Failure