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How Effective Is Endovascular Intracranial Revascularization in Stroke Prevention? Results from Borgess Medical Center Intracranial Revascularization Registry

How Effective Is Endovascular Intracranial Revascularization in Stroke Prevention? Results from... This Article Full Text Full Text (PDF) All Versions of this Article: ajnr.A2670v1 32/7/1227 most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Al-Ali, F. Articles by Walker, S. PubMed PubMed Citation Articles by Al-Ali, F. Articles by Walker, S. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 32:1227-1231, August 2011 © 2011 American Society of Neuroradiology INTERVENTIONAL How Effective Is Endovascular Intracranial Revascularization in Stroke Prevention? Results from Borgess Medical Center Intracranial Revascularization Registry F. Al-Ali a ,c , T. Cree b , L. Duan d , S. Hall e , A. Jefferson b , S. Louis c , K. Major c , S. Smoker c and S. Walker b a From Neurosurgery of Kalamazoo (F.A.-A.), Kalamazoo, Michigan b Borgess Research Institute (T.C., A.J., S.W.) c Neurointerventional Surgery and Diagnostic Services (F.A.-A., S.L., K.M., S.S.), Borgess Medical Center, Kalamazoo, Michigan d Independent Statistical Consultant (L.D.), Chicago, Illinois e Kalamazoo Center for Medical Studies (S.H.), Michigan State University, Kalamazoo, Michigan. Please address correspondence to Firas Al-Ali, MD, Neurosurgery of Kalamazoo, 1541 Gull Rd, Ste 200, Kalamazoo, MI 49048; e-mail: firasalali@aol.com BACKGROUND AND PURPOSE: The WASID study established the risk of subsequent ischemic stroke at 1 year in subjects with symptomatic intracranial atherosclerotic stenosis (70%–99%) at 18%. The efficacy of different methods of endovascular revascularization in stroke prevention still has not been established. We compared the stroke rate in our registry at 1 year following intervention with the WASID results to identify which method, if any, provides the most benefit in stroke prevention. This result from the BMC-IRR follows a previously published article comparing stent placement and angioplasty outcomes. MATERIALS AND METHODS: We maintained a nonrandomized single-center single-operator registry of consecutive symptomatic patients who underwent endovascular intracranial revascularization. Data were collected prospectively and retrospectively and analyzed retrospectively. Patients were treated with angioplasty, BMS, or self-expanding WS. To make our data comparable with that in the WASID study, we selected patients with a single lesion of 50%–99% stenosis undergoing a single intervention. Data was collected on patients until symptom recurrence, repeat intervention, or 1 year postintervention, whichever occurred first. RESULTS: We found that 115 patients fit the inclusion criteria, with 38 angioplasty, 28 BMS, and 49 WS cases. For patients with 70%–99% stenosis, the overall probability of stroke at 1 year postintervention was 19.3%. The overall stroke probability per device, independent of clinical presentation, was 12.5% for angioplasty, 20.2% for BMS, and 24.1% for WS. CONCLUSIONS: Compared with the WASID data, angioplasty appears to have a lower stroke rate after 1 year than medical therapy alone. However, neither stent-placement arm compared favorably with the WASID results. Abbreviations: ACA, anterior cerebral artery • BA, basilar artery • BCC-IRR, Borgess Medical Center Intracranial Revascularization Registry • BMS, balloon-mounted stent • BMT, best medical therapy • CI, confidence interval • ICA, internal carotid artery • MCA, middle cerebral artery • mRS, modified Rankin Scale • SAMMPRIS, Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis • SSYLVIA, Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries • TIA, transient ischemic attack • VA, vertebral artery • WASID, Warfarin-Aspirin Symptomatic Intracranial Disease • WS, Wingspan stent Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2011 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

How Effective Is Endovascular Intracranial Revascularization in Stroke Prevention? Results from Borgess Medical Center Intracranial Revascularization Registry

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2011 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A2670
Publisher site
See Article on Publisher Site

Abstract

This Article Full Text Full Text (PDF) All Versions of this Article: ajnr.A2670v1 32/7/1227 most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Al-Ali, F. Articles by Walker, S. PubMed PubMed Citation Articles by Al-Ali, F. Articles by Walker, S. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 32:1227-1231, August 2011 © 2011 American Society of Neuroradiology INTERVENTIONAL How Effective Is Endovascular Intracranial Revascularization in Stroke Prevention? Results from Borgess Medical Center Intracranial Revascularization Registry F. Al-Ali a ,c , T. Cree b , L. Duan d , S. Hall e , A. Jefferson b , S. Louis c , K. Major c , S. Smoker c and S. Walker b a From Neurosurgery of Kalamazoo (F.A.-A.), Kalamazoo, Michigan b Borgess Research Institute (T.C., A.J., S.W.) c Neurointerventional Surgery and Diagnostic Services (F.A.-A., S.L., K.M., S.S.), Borgess Medical Center, Kalamazoo, Michigan d Independent Statistical Consultant (L.D.), Chicago, Illinois e Kalamazoo Center for Medical Studies (S.H.), Michigan State University, Kalamazoo, Michigan. Please address correspondence to Firas Al-Ali, MD, Neurosurgery of Kalamazoo, 1541 Gull Rd, Ste 200, Kalamazoo, MI 49048; e-mail: firasalali@aol.com BACKGROUND AND PURPOSE: The WASID study established the risk of subsequent ischemic stroke at 1 year in subjects with symptomatic intracranial atherosclerotic stenosis (70%–99%) at 18%. The efficacy of different methods of endovascular revascularization in stroke prevention still has not been established. We compared the stroke rate in our registry at 1 year following intervention with the WASID results to identify which method, if any, provides the most benefit in stroke prevention. This result from the BMC-IRR follows a previously published article comparing stent placement and angioplasty outcomes. MATERIALS AND METHODS: We maintained a nonrandomized single-center single-operator registry of consecutive symptomatic patients who underwent endovascular intracranial revascularization. Data were collected prospectively and retrospectively and analyzed retrospectively. Patients were treated with angioplasty, BMS, or self-expanding WS. To make our data comparable with that in the WASID study, we selected patients with a single lesion of 50%–99% stenosis undergoing a single intervention. Data was collected on patients until symptom recurrence, repeat intervention, or 1 year postintervention, whichever occurred first. RESULTS: We found that 115 patients fit the inclusion criteria, with 38 angioplasty, 28 BMS, and 49 WS cases. For patients with 70%–99% stenosis, the overall probability of stroke at 1 year postintervention was 19.3%. The overall stroke probability per device, independent of clinical presentation, was 12.5% for angioplasty, 20.2% for BMS, and 24.1% for WS. CONCLUSIONS: Compared with the WASID data, angioplasty appears to have a lower stroke rate after 1 year than medical therapy alone. However, neither stent-placement arm compared favorably with the WASID results. Abbreviations: ACA, anterior cerebral artery • BA, basilar artery • BCC-IRR, Borgess Medical Center Intracranial Revascularization Registry • BMS, balloon-mounted stent • BMT, best medical therapy • CI, confidence interval • ICA, internal carotid artery • MCA, middle cerebral artery • mRS, modified Rankin Scale • SAMMPRIS, Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis • SSYLVIA, Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries • TIA, transient ischemic attack • VA, vertebral artery • WASID, Warfarin-Aspirin Symptomatic Intracranial Disease • WS, Wingspan stent Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2011 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Aug 1, 2011

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