Balloon Angioplasty for Intracranial Atherosclerotic Disease. Periprocedural Risks and Short-Term Outcomes in a Multicenter Study
Balloon Angioplasty for Intracranial Atherosclerotic Disease. Periprocedural Risks and Short-Term Outcomes in a Multicenter Study( December 2010)
Thanh N. Nguyen MD*; Osama O. Zaidat MD; Rishi Gupta MD; Raul G. Nogueira MD; Nauman Tariq MD; Junaid S. Kalia MD; Alexander M. Norbash MD; and Adnan I. Qureshi MD
Whether stenting is superior toangioplasty in the treatment of intracranial atheroscleroticdisease is unknown. Dissections, vessel rupture, and lesionrecoil observed with primary angioplasty using balloon cathetersdesigned for coronary arteries have undermined the role of primaryangioplasty as a preferred treatment for intracranial atheroscleroticdisease. The goal of this study is to report the immediate and3-month outcomes of treating patients with intracranial atheroscleroticdisease with angioplasty balloon catheters in a multicenterstudy.
In this retrospective review, 74 patientsfrom 4 institutions treated with primary angioplasty for intracranialatherosclerotic disease over a 6-year time period. Technicalsuccess (residual stenosis 
50%), periprocedural success (novascular complication within 72 hours), and 3-month outcomesare reported.
50%), periprocedural success (novascular complication within 72 hours), and 3-month outcomesare reported.The mean degree of stenosis pretreatmentwas 79%±14% and reduced to 34%±18% after angioplasty.Technical success was achieved in 68 (92%; 95% CI, 83% to 97%)of the 74 patients. Periprocedural success was achieved in 65(88%; 95% CI, 78% to 94%) of the 74 patients. There were 4 (5%;95% CI, 1.5% to 13%) major procedure-related strokes, 2 of whichresulted in death within 6 hours of the procedure. The 30-daystroke/death rate was 5% (4 of 74; CI, 1.5% to 13%). Three-monthfollow-up was available in 71 patients. In this interval, 2patients had new stroke, 1 in the ipsilateral territory andthe other in the contralateral territory. The 3-month strokeor death rate was 8.5% (6 of 71; CI, 3.1% to 17.5%); the retreatmentrate was 2.8% (2 of 71; CI, 0.3% to 10%).
From the above findings the authors concluded that balloonangioplasty is a relatively safe alternative treatment for intracranialatherosclerotic disease. Its role in the long-term secondaryprevention of recurrent stroke as compared with intracranialstenting and medical therapy remains to be determined, preferablyin a randomized study.
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