title: Comparison of outcomes and utilization of extracranial-intracranial bypass versus intracranial stenting for intracranial stenosis.
abstract: BACKGROUND
  Extracranial-intracranial (EC-IC) bypass and intracranial stenting (ICS) are both revascularization procedures that have emerged as treatment options for intracranial atherosclerotic disease (ICAD). This study describes and compares recent trends in utilization and outcomes of intracranial revascularization procedures in the United States using a population-based cohort. It also investigates the association of ICS and EC-IC bypass with periprocedural morbidity and mortality, unfavorable discharge status, length of stay (LOS), and total hospital charges.
  
  
  METHODS
  The National Inpatient Sample (NIS) was queried for patients with ICAD who underwent EC-IC bypass or ICS during the years 2004-2010. Patient characteristics, demographics, perioperative complications, outcomes, and discharge data were collected.
  
  
  RESULTS
  There were 627 patients who underwent ICS and 249 patients who underwent EC-IC bypass. Patients who underwent ICS were significantly older (P < 0.001) with more comorbidities (P = 0.027) than those who underwent EC-IC bypass. Patients who underwent EC-IC bypass experienced higher rates of postprocedure stroke (P = 0.014), but those who underwent ICS experienced higher rates of death (P = 0.006). Among asymptomatic patients, the rates of postprocedure stroke (P = 0.341) and death (P = 0.887) were similar between patients who underwent ICS and those who underwent EC-IC bypass. Among symptomatic patients, however, there was a higher rate of postprocedure stroke in patients who underwent EC-IC bypass (P < 0.001) and a higher rate of death among patients who underwent ICS (P = 0.015).
  
  
  CONCLUSIONS
  The ideal management of patients with ICAD cannot yet be defined. Although much data from randomized and prospective trials on revascularization have been collected, many questions remain unanswered. There still remain cohorts of patients, specifically patients who have failed aggressive medical management, where not enough evidence is available to dictate decision-making. In order to further elucidate the safety and efficacy of these intracranial revascularization procedures, further clinical trials are needed.
authors.affiliation: Department of Neurosurgery, New York University School of Medicine, NY, USA.
authors.forename: Taylor A
authors.initials: TA
authors.lastname: Wilson
authors.affiliation: Department of Neurosurgery, New York University School of Medicine, NY, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Tanweer
authors.affiliation: Department of Neurosurgery, New York University School of Medicine, NY, USA.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, New York University School of Medicine, NY, USA.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Riina
keywords: Extracranial–intracranial bypass; National inpatient sample database; intracranial atherosclerotic disease; intracranial stenosis; intracranial stenting