Comparison of clinical and angiographic outcomes of angioplasty and stenting in patients with intracranial arterial stenosis： a case series study

Abstract

Objective To compare the clinical efficacy and angiographic outcomes of balloon dilation angioplasty, balloon-expandable stent implantation and self-expanding stent implantation in the treatment of intracranial arterial stenosis. Methods The patients with intracranial arterial stenosis who met the indications of shrgical intervention treated with balloon dilatation angioplasty and stent placement were selected from Nanjing Stroke Registry Program. According to the different interventional procedures, the patients were divided into the balloon expandable stenting group, the self-expanding stents group and the balloon dilatation angioplasty group. The success rate of surgery, the perioperative complication rate and the significant residual stenosis rate were cmpared among the three groups. The clinical and angiographic assessments were performed through 1-, 3-, 6-, 12- and 24-month regular outpatient or inpatient follow-up after procedure. The incidences of ischemic strokeand/or death and restenosis within 2 years were compared. Multivariate Cox proportional hazards analysis was used to analyze the risk factors for recurrent ischemic stroke and/or death and restenosis. Results A total of 183 patients with 192 stenoses performed balloon dilatation angioplasty or stenting, in which 92 were in the balloon expandable stenting group, 42 were in the serf-expanding stents goup and 49 in the balloon dilatation angioplasty group, Their preoperative stenosis rates were 80. 2 ±12. 8% ,76. 3 ± 11. 9% and 89. 7± 10. 2%, respectively （F = 15. 863, P =0. 000）. There were no significant differences in other baseline data. The success rates of surgery in the balloon expandable stenting group, self-expanding stents group and balloon dilatation angioplasty group were 96. 7%, 95. 2% and 91.8%, respectively （x2 = 1. 646, P =0. 439）. The perioperative complication rates were 6. 5%, 14. 3% and 10. 2%, respectively （Fisher exact test, P =0. 334）. The imaging follow-up showed that the restenosis rate in the balloon dilatation angioplasty group was 48. 5%. Although it was high than 27. 7% in the balloon expandable stenting group and 34. 8% in the self-expanding stents group, there were no significant differences （X2 = 4. 176, P = 0. 124）. Multivariate Cox proportional hazards analysis showed that balloon dilatation angioplasty was an independent risk factor for restenosis after procedure （hazard ratio 2. 490, 95% confidence interval 1. 247 - 4. 969, P = 0. 010）. Conclusions Compared to the balloon expandable stenting, the balloon dilatation angioplasty is more likely to have restenosis, but it is not associated with the risks of postoperative recurrent iscliemic stroke and/or death. Key words: Intracranial Arteriosclerosis; Angioplasty; Stents; Cerebral Angiography; Treatment Outcome