Study Supports Elective Catheter-Based Treatment of Intracranial Stenoses

July 1, 2012—A study of interventional cardiologists performing elective percutaneous intervention with catheter-based therapy (CBT) for intracranial atherosclerotic stenoses was published by Ramy A. Badawi MBBS, et al in Catheterization and Cardiovascular Interventions (2012;80;121–127).

The investigators found that for patients with symptomatic intracranial arterial stenosis who have failed medical therapy or are considered very high risk for stroke, CBT performed by experienced interventional cardiologists is safe and offers both high procedural success rates and excellent clinical outcomes at 1 year.

As summarized in Catheterization and Cardiovascular Interventions, the background of the study is that current best medical therapy with antiplatelet and/or antithrombotic agents for symptomatic atherosclerotic intracranial disease is associated with high recurrence. Intracranial CBT using balloon angioplasty with or without stent placement is an option for patients who have failed medical therapy. The investigators sought to examine the outcomes of CBT for patients with symptomatic intracranial arterial disease managed by experienced interventional cardiologists.

The investigators reported that they retrospectively studied 89 consecutive symptomatic patients with 99 significant (≥ 70% diameter) intracranial arterial stenoses who underwent CBT. CBT was performed by experienced interventional cardiologists with the consultative support of a neurovascular team. The primary endpoint was stroke and vascular death. Procedure success was achieved in 96 of 99 (97%) lesions and percent diameter stenosis was reduced from 91% ± 7.5% preprocedure to 19% ± 15% postprocedure (P < .001). The rate of in-hospital periprocedural stroke and all death was 3%. The primary endpoint of stroke and vascular death rate at 1 year was 5.7% (5/88) and at 2 years was 13.5% (11/81). The 2-year all-cause mortality was 11.3% (10/88).

The investigators concluded that CBT is an attractive option for this high-risk patient population, considering the expected 12% to 15% rate of recurrent stroke at 1 year.