Adjuvant revascularization of intracranial artery occlusion with angioplasty and/or stenting.
BACKGROUND
In conjunction with intravenous and/or intra-arterial thrombolysis, adjuvant revascularization of intracranial artery occlusion by angioplasty vs. stenting remains controversial. We evaluated outcome in patients with intracranial occlusion after angioplasty and/or stenting.


METHODS
Thirty-three patients who underwent angioplasty or stenting (17 stenting and 16 angioplasty) for intracranial arterial occlusion during the past 5 years were enrolled from prospective neurointerventional database. We compared recanalization rate [defined as thrombolysis in myocardial infarction (TIMI) grade II/III flow], adverse events, and clinical outcome [modified Rankin scale (mRS) at 1 and 6 months]. We also tried to determine independent variables associated with clinical outcome.


RESULTS
Median initial National Institutes of Health Stroke Scale (NIHSS) was 13 and median time to treatment was 12 h from symptom onset. The successful recanalization rate was mean 79%. Symptomatic hemorrhage occurred in 15% (5/33). Events (27%, 9/33) at 1 month included four deaths, four major, and one minor stroke. Good outcome (mRS <or= 2) was achieved in 17 patients (52%) at 6 months and was significantly related to age, initial NIHSS, TIMI flow, and stenting on bivariate analysis. On multivariable analysis, stenting was the only variable significantly associated with a 6-month, good clinical outcome (OR, 14.48; 95% CI, 1.76 to 118.93; p = 0.013)


CONCLUSIONS
Intracranial revascularization with angioplasty and/or stenting may improve the clinical outcome in selected patients with intracranial occlusion. Multiple factors are related to favorable clinical outcome.
Choi
Jin Woo
JW
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-Gu, Seoul, 138-736, Korea.
Kim
Jae Kyun
JK
Choi
Byung Se
BS
Kim
Jeoung Hyun
JH
Hwang
Hae Jun
HJ
Kim
Jong Sung
JS
Kim
Sang Joon
SJ
Suh
Dae Chul
DC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D017130:Angioplasty / Q000379:methods*; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000150:complications; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome; D055815:Young Adult