Comparison Of Primary Angioplasty With Different Types Of Stent For Treating Intracranial Artery Stenosis

Background and purposeIntracranial atherosclerosis accounts for approximately30%of ischemic strokes in Asian people[1]. The Warfarin versus Aspirin for Symptomatic Intracranial Disease Study (WASID) had shown that23%of the patients with a TIA or stroke attributable to a high-grade intracranial stenosis would have a further ipsilateral ischemic stroke over the next year in that trial despite medical therapy[2]. Recurrent cerebral ischemic event rates in antithrombotic failure cases may even reach as high as52%[3]. Percutaneous angioplasty for symptomatic intracranial stenosis, refractory to medical management, was initially reported in the1980s[4].And In the early1990s, the development of newer-generation, more flexible, microballoon catheters intended for cerebrovascular use and smaller balloon-expandable stents, initially introduced for coronary applications, increased the technical success rates and increased the interest in these therapeutic options. Then in2005, the Wingspan Stenting System (Boston Scientific) was approved by the FDA for use under an HDE (humanitarian device exemption) in patients with symptomatic intracranial stenosis. Some authors have proposed theoretical advantages of stent placement over primary angioplasty by preventing early elastic recoil and negative remodeling[5,while others suggested that there was no difference of the clinical outcomes[6].Whether stenting is superior than angioplasty alone is still a problem[7]. Recent data showed that the SES has a higher restenosis rate than BMS, but it’s still lack of the clinical data [8]. To investigate clinical efficacy and angiographic outcomes of primary angioplasty and different stents in treatment of the stenosis of intracranial artery, we performance the present study.MethodsThe data of188patients undergoing percutaneous transluminal angioplasty (PTA) alone or single stent placement in the intracranial artery were retrieved. According to the intervention, the patients were divided into three groups:95patients in balloon-mounted stents (BMS)group,44in self-expandable stents (SES)group, and49in PTA group. Average clinical follow-up time was13.9months, and average image follow-up time was9.0months. COX regression model was used to analyze the clinical and angiographic outcomes.ResultsA total of49PTAs were done for49patients, and148stents were implanted for139patients. The rates of successful intervention in BMS group, SES group and PTA group were96.8%.95.5%and91.8%respectively(P>0.05),and the lumen gain of the PTA group was smaller. The incidence of periprocedural stroke and(or)death was6.3%in BMS group,13.6%in SES group and10.2%in PTA group, there was no statistically significant difference among the three groups(P>0.05). There was no statistical significance difference in the incidence of follow-up stroke and(or)death between the three groups(10.0%、6.8%and13.0%respectively,P>0.05). The incidence of in-stent restenosis (ISR) after intervention in the angioplasty group was higher than that in the BMS group and SES group(48.8%vs26.0%vs36.1%, χ2=6.225, P=0.044). PTA alone was more inclined to restenosis by multivariate Cox regression model analysis(HR=2.449,95%CI=1.301-4.612, P=0.006).ConclusionPTA alone is more inclined to restenosis after intervention procedural, but it is not related to the clinical outcomes.