Comparison of Primary Angioplasty with Stent Placement for Treating Symptomatic Intracranial Atherosclerotic Disease

INTRODUCTION: To compare the clinical outcomes of primary angioplasty versus stent placement for symptomatic intracranial atherosclerosis. METHODS: We retrospectively analyzed the clinical and angiographic data of 190 patients treated with 95 angioplasties alone and 98 intracranial stents in three tertiary care centers. Significant postoperative residual stenosis (50% stenosis) and significant restenosis (50% stenosis at follow-up angiogram) were identified as angiographic end points. Stroke and combined stroke and/or death were identified as clinical endpoints during the periprocedural and follow-up periods. RESULTS: Fourteen procedures in the angioplasty (15%) and four in the stent group (4.1%) had significant postoperative residual stenosis (RR, 2.8; 95% CI, 0.85–9.5; P = 0.09). There were three periprocedural deaths ([1.5%], one in the angioplasty [1.1%] and two in the stent-treated group [2.0%]) and 14 periprocedure strokes ([7.3%], seven periprocedure strokes in each group [7.4 and 7.1% respectively; HR, 1.1; 95% CI, 0.57–1.9; P = 0.85]). Angiographic follow-up was available for 134 procedures (66 angioplasties, 68 stent treatments). Forty-eight procedures (36.1%) had evidence of significant restenosis (25 of 66 angioplasties, 23 of 68 stents, P = 0.85). Significant restenosis-free survival at 12 months was 68% for the angioplasty-treated group and 64% for the stent-treated group. There was no difference in follow-up survival (stroke or stroke and/or death) between the angioplasty and stent groups (HR, 0.54; 95% CI, 0.11–2.5; P = 0.44 and HR, 0.50; 95% CI, 0.17–1.5; P = 0.22, respectively, after adjusting for age, sex, and center). The stroke and/or death-free survival at 2 years for the angioplasty group and the stent treated group was 92 ± 4 and 89 ± 5%, respectively. CONCLUSION: Stent treatment for intracranial atherosclerosis may lower the rate of significant postoperative residual stenosis as compared with primary angioplasty alone. No benefit of stent placement over primary angioplasty in reducing significant restenosis rate, stroke, or stroke and/or death could be identified in this study.