title: How effective is endovascular intracranial revascularization in stroke prevention? Results from Borgess Medical Center Intracranial Revascularization Registry.
abstract: OBJECTIVE
  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.
  
  
  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 stent-placement arm compared favorably with the WASID results.
authors.affiliation: Neurosurgery of Kalamazoo, Kalamazoo, Michigan, USA. firasalali@aol.com
authors.forename: F
authors.initials: F
authors.lastname: Al-Ali
authors.forename: T
authors.initials: T
authors.lastname: Cree
authors.forename: L
authors.initials: L
authors.lastname: Duan
authors.forename: S
authors.initials: S
authors.lastname: Hall
authors.forename: A
authors.initials: A
authors.lastname: Jefferson
authors.forename: S
authors.initials: S
authors.lastname: Louis
authors.forename: K
authors.initials: K
authors.lastname: Major
authors.forename: S
authors.initials: S
authors.lastname: Smoker
authors.forename: S
authors.initials: S
authors.lastname: Walker
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000368:Aged; D017130:Angioplasty / Q000706:statistics & numerical data*; D002548:Cerebral Revascularization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D015607:Stents / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome