Abstract:

Objective To investigate whether symptomatic severe intracranial atherosclerotic stenosis was associated with a higher subsequent stroke risk than moderate stenosis after elective angioplasty with balloon-expandable stent and to explore which factors were associated with the subsequent stroke.Methods During September 2001 till June 2005,there were 220 symptomatic intracranial atherosclerotic stenoses in 213 patients undergoing elective stenting at our institute.Of these stenoses,126 in 121 patients had ≥70% severe stenoses,and 94 in 92 patients had 50%～69% moderate stenoses.Primary endpoints included lesion-related ischemic stroke,and symptomatic brain or subarachnoid hemorrhages.Results Ten primary endpoint events occurred in the severe stenosis group(six within 30 days and four in mean follow-up of 26.0 months after 30 days),and seven occurred in the moderate stenosis group(four within 30 days and 3 in mean follow-up of 27.6 months after 30 days).There was no significant difference in cumulative probability of primary endpoints between the severe(7.2% at 1 year and 8.2% at 2 years) and moderate(5.3% at 1 year and 8.3% at 2 years) stenoses groups.No single factor was found to be associated with primary endpoints in the moderate stenosis group.Multivariable analysis revealed that stent failure was the only predictor of primary endpoints in the severe stenosis group(hazard 5.31,95% CI 1.35 to 20.91).Conclusion Symptomatic severe intracranial atherosclerotic stenosis did not present a higher subsequent stroke risk than moderate stenosis after elective angioplasty with balloon-expandable stent.Patients with severe stenosis may benefit from successful stent placement,and randomized trials are necessary to demonstrate this possible benefit.

Key words: atherosclerosis, intracranial artery, stenosis, angioplasty, stent