[Long-term outcome after endovascular treatment of high-risk patients with recurrently symptomatic intracranial stenoses of the posterior circulation].
OBJECTIVE
We present long-term clinical and duplex data from high-risk patients with severe, recurrent symptomatic stenoses of the vertebrobasilar circulation. We hypothesized that despite the greater risk of periprocedural complications in this patient group, interventional treatment would reduce the risk of recurrent strokes relative to the expected natural risk. We also predicted that the long-term treatment outcome would be positively influenced by the use of stents and by the periprocedural technical success rate.


METHODS
An analysis of our patient data base yielded 45 cases of stenosis of the vertebrobasilar circulation treated endovascularly in 42 patients between 1998 and 2006. Clinical and vascular diagnostic tests, both periinterventionally and during follow-up, were performed independently by experienced neurologists.


RESULTS
The technical success rate was 93%. Stents were used in 67% of the procedures. After 30 days, 24% of the patients showed post-procedural clinical deterioration. After an average period of 26.3 months, 17.8 % of the patients had deteriorated. 11.1% of the patients suffered severe permanent damage as a result of the procedure (mRs 3 - 6). Restenosis was found in 9.5% of the cases. There were no instances of a recurrent stroke during follow-up.


CONCLUSIONS
For this population of high-risk patients with recurrently symptomatic intracranial stenoses of the vertebrobasilar axis, endovascular treatment reduced the risk of stroke and death relative to the expected natural risk. The use of stents had no significant effect on the long-term results.
Wittkugel
O
O
Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf. wittkugelo@web.de
Rosenkranz
M
M
Burckhardt
D
D
Niessen
W D
WD
Espersen
T
T
Zeumer
H
H
Fiehler
J
J
Grzyska
U
U
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D000925:Anticoagulants / Q000008:administration & dosage; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D020769:Posterior Cerebral Artery; D012008:Recurrence; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D017585:Ultrasonography, Doppler, Transcranial; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors