High Risk of Recurrent Ischemic Events Among Patients With Deferred Intracranial Angioplasty and Stent Placement for Symptomatic Intracranial Atherosclerosis

Abstract

Intracranial angioplasty with or without stent placement has been performed to treat patients with recurrent cerebral ischemic events despite best medical therapy or those with high-grade stenosis. To evaluate early recurrent stroke/transient ischemic attack rates in a cohort of patients with symptomatic >50% intracranial stenosis in whom intracranial angioplasty and stent placement was initially deferred. All patients presenting to 2 academic hospitals with symptomatic intracranial disease between 2006 and 2008 who underwent catheter angiography were identified. Patients with complete intracranial occlusion or stenosis less than 50% stenosis were excluded (n = 14). Thirty-one patients met the study criteria. Sixteen (52%) patients were on antiplatelet medications at the time of the initial event, and 2 patients were also on anticoagulant medications. Six patients (19%) underwent intracranial angioplasty and/or stent placement with their initial diagnostic angiogram. Twenty-five patients (81%) had endovascular treatment deferred for best medical treatment in the interim period. Among the 25 patients who were kept on medical management, 14 (56%) were readmitted with recurrent ischemic events in the distribution of the target artery within a median of 28 days (range, 1-243 days). Recurrent events occurred within 1 week in 8 (57%) patients, between 7 days and 1 month in 4 (29%) patients, 1 to 3 months in 1 (7%) patient, and after 3 months in 1 (7%) patient. Recurrent ischemic events were observed in all 5 patients with basilar artery stenosis and in 13 of 17 patients with severity of stenosis ≥ 70%. A high rate of recurrent ischemic events was observed among patients in whom endovascular treatment was deferred, particularly those with basilar artery stenosis and those with high-grade stenosis. This information would be beneficial in decision making for timing of the endovascular treatment among patients with symptomatic intracranial stenosis.