Management strategies in posterior circulation intracranial atherosclerotic disease.
OBJECTIVE
To assess the short-term prognosis of patients with recent symptomatic intracranial atherosclerotic disease in the posterior circulation and evaluate differences in the outcome of patients receiving medical or endovascular treatment.


METHODS
The records of 50 consecutive patients with symptomatic intracranial atherosclerotic disease in the posterior circulation were reviewed to record the occurrence of transient ischemic attack, stroke, major bleeding, and/or death during the 12-month period following a neurological event. Twenty-five patients received medical treatment alone, 13 initially received medical treatment and subsequently were treated with angioplasty/stenting due to recurrent events (analyzed in both groups), and 12 patients received endovascular treatment initially. The crossover patients were considered as 1 treated patient in each group; thus, there were 38 subjects (33 men; mean age 68+/-9 years) receiving medical therapy compared with 25 patients (21 men; mean age 63+/-13 years) who underwent endovascular procedures.


RESULTS
During the 12-month period, subjects in the medically-treated group had a higher rate of events (37%, 14/38) than patients who received angioplasty/stenting (12%, 3/25; p = 0.042). Notably, there were 7 (18%) TIAs and 6 (16%) strokes in medically-treated patients versus no TIAs (0%, p = 0.035) and only 2 (8%, p = NS) strokes in the endovascular group, both of which occurred within 48 hours of the procedure. There were no deaths and only a single major bleeding event in each group.


CONCLUSIONS
Endovascular treatment of patients with symptomatic intracranial disease of the posterior territory appears to be associated with a substantially better outcome.
Povedano
Guillermo
G
Department of Neurology, Institute for Neurological Research, FLENI, Buenos Aires, Argentina.
Zuberbuhler
Paz
P
Lylyk
Pedro
P
Ameriso
Sebastian F
SF
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D001118:Argentina; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002560:Cerebrovascular Circulation; D016009:Chi-Square Distribution; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents