CONCURRENT COMPARISON OF OUTCOMES OF PRIMARY ANGIOPLASTY AND OF STENT PLACEMENT IN HIGH-RISK PATIENTS WITH SYMPTOMATIC INTRACRANIAL STENOSIS

OBJECTIVE To compare the long-term outcomes of treatment of symptomatic intracranial stenosis using primary angioplasty or stent placement. Both primary angioplasty and stent placement have been proposed as treatment modalities, but long-term outcome comparisons are not available. METHODS We determined rates of technical success and rates of major stroke, second procedure, or death in patients with symptomatic intracranial stenosis (≥70% in severity and/or medication failure). Pre- and posttreatment angiographic stenosis was measured by independent reviewers. Angioplasty was used preferentially in patients with more technically challenging lesions. Kaplan-Meier analysis was used to determine the rate of major stroke–free survival and major stroke– or repeat procedure–free survival between the two treatment modalities over periods of 12 and 24 months. Cox proportional hazards analysis was used to determine the differential risk of major stroke or death after either angioplasty or stent placement. RESULTS Twenty-two patients (mean age, 62 ± 13 yr) were treated with primary angioplasty and 22 patients (mean age, 58 ±14 yr) with stent placement. The mean stenosis (±standard deviation) decreased from 76 ± 13% to 28 ± 18% in the primary angioplasty–treated and from 68 ± 9% to 17 ± 13% in the stent-treated group. There was no difference in time to major stroke or death (log-rank statistic, 0.44; P = 0.5), and time to major stroke, repeat procedure, or death (log-rank statistic, 0.78; P = 0.4) between the two treatment groups. At 12 months, major stroke–free survival was 95% (± standard error of 4%) for the stent-treated patients and 93% (± standard error of 7%) for the angioplasty-treated patients. There was no significant difference in the risk of major stroke or death between angioplasty and stent placement (P = 0.996) using Cox proportional hazards analysis after adjusting for age, gender, race/ethnicity, presence of hyperlipidemia, qualifying event, preprocedure stenosis, and target vessel. CONCLUSION The results of primary angioplasty and primary stent placement were comparable at intermediate follow-up examination after the procedure. The results highlight the need for carefully designed, randomized clinical trials to determine the precise value of stent placement in the intracranial circulation.