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<meta name="DC.Title" content="Predictors of Unfavorable Outcome in Intracranial Angioplasty and Stenting in a Single-Center Comparison: Results from the Borgess Medical Center-Intracranial Revascularization Registry" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2530" />
<meta name="DC.Date" content="2011-08-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Intracranial angioplasty and stent placement are used to treat intracranial atherosclerotic disease. The 2 interventions have not been directly compared.

MATERIALS AND METHODS: This was a single-center, single-operator registry of consecutive, symptomatic subjects receiving treatment (angioplasty, BMS, or WS, chosen based on safety as judged by the operator). After November 2005, angioplasty alone was abandoned following the introduction of the WS. The primary end point was stroke rate per intervention at 30 days. The secondary end point was stroke rate per patient beyond 30 days. Success, dissection, restenosis, and occlusion rates were tracked.

RESULTS: From April 2002 to January 2009, 140 subjects with 159 lesions (50%–100% stenosis) underwent 209 interventions: 89 angioplasty, 47 BMS, and 73 WS cases. Overall stroke rate at 30 days was 12.9%. The angioplasty arm had the lowest stroke rate (4.5%), whereas the WS arm had the highest (24.7%; P = .0002), leaving the BMS with 10.7%. Stroke rate beyond 30 days was 9%. The success rate was 58.4% for angioplasty, 81.3% for BMS, and 94.4% for WS, whereas the restenosis rates were 28.2%, 5.8%, and 13.3%, respectively. Dissection increased the risk of stroke in the first 30 days ( P = .0439) and restenosis ( P = .0051). Perforator vessels were more likely than nonperforators to have stroke within 30 days ( P = .008). Eccentric lesions were more likely to have stroke than concentric lesions ( P = .0726).

CONCLUSIONS: In this comparison, angioplasty had a significantly lower stroke rate than WS. Certain lesion locations, morphologic characteristics, and the presence of dissection after treatment were other predictors of unfavorable outcome.

ACA
:   anterior cerebral artery
BA
:   basilar artery
BMC-IRR
:   Borgess Medical Center-Intracranial Revascularization Registry
BMS
:   balloon-mounted stent
DCA
:   diagnostic cerebral angiogram
DES
:   drug-eluting stent
ICA
:   internal carotid artery
IRB
:   Institutional Review Board
MCA
:   middle cerebral artery
mRS
:   modified Rankin Scale
TIA
:   transient ischemic attack
VA
:   vertebral artery
VBJ
:   vertebrobasilar junction
WASID
:   Warfarin-Aspirin Symptomatic Intracranial Disease
WS
:   wingspan stent system" />
<meta name="DC.Contributor" content="F. Al-Ali" />
<meta name="DC.Contributor" content="T. Cree" />
<meta name="DC.Contributor" content="S. Hall" />
<meta name="DC.Contributor" content="S. Louis" />
<meta name="DC.Contributor" content="K. Major" />
<meta name="DC.Contributor" content="S. Smoker" />
<meta name="DC.Contributor" content="S. Walker" />
<meta name="article:published_time" content="2011-08-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Predictors of Unfavorable Outcome in Intracranial Angioplasty and Stenting in a Single-Center Comparison: Results from the Borgess Medical Center-Intracranial Revascularization Registry" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Intracranial angioplasty and stent placement are used to treat intracranial atherosclerotic disease. The 2 interventions have not been directly compared.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;This was a single-center, single-operator registry of consecutive, symptomatic subjects receiving treatment (angioplasty, BMS, or WS, chosen based on safety as judged by the operator). After November 2005, angioplasty alone was abandoned following the introduction of the WS. The primary end point was stroke rate per intervention at 30 days. The secondary end point was stroke rate per patient beyond 30 days. Success, dissection, restenosis, and occlusion rates were tracked.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;From April 2002 to January 2009, 140 subjects with 159 lesions (50%–100% stenosis) underwent 209 interventions: 89 angioplasty, 47 BMS, and 73 WS cases. Overall stroke rate at 30 days was 12.9%. The angioplasty arm had the lowest stroke rate (4.5%), whereas the WS arm had the highest (24.7%; &lt;i&gt;P&lt;/i&gt; = .0002), leaving the BMS with 10.7%. Stroke rate beyond 30 days was 9%. The success rate was 58.4% for angioplasty, 81.3% for BMS, and 94.4% for WS, whereas the restenosis rates were 28.2%, 5.8%, and 13.3%, respectively. Dissection increased the risk of stroke in the first 30 days (&lt;i&gt;P&lt;/i&gt; = .0439) and restenosis (&lt;i&gt;P&lt;/i&gt; = .0051). Perforator vessels were more likely than nonperforators to have stroke within 30 days (&lt;i&gt;P&lt;/i&gt; = .008). Eccentric lesions were more likely to have stroke than concentric lesions (&lt;i&gt;P&lt;/i&gt; = .0726).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;In this comparison, angioplasty had a significantly lower stroke rate than WS. Certain lesion locations, morphologic characteristics, and the presence of dissection after treatment were other predictors of unfavorable outcome.&lt;/p&gt;" />
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<meta name="twitter:title" content="Predictors of Unfavorable Outcome in Intracranial Angioplasty and Stenting in a Single-Center Comparison: Results from the Borgess Medical Center-Intracranial Revascularization Registry" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Intracranial angioplasty and stent placement are used to treat intracranial atherosclerotic disease. The 2 interventions have not been directly compared.

MATERIALS AND METHODS: This was a single-center, single-operator registry of consecutive, symptomatic subjects receiving treatment (angioplasty, BMS, or WS, chosen based on safety as judged by the operator). After November 2005, angioplasty alone was abandoned following the introduction of the WS. The primary end point was stroke rate per intervention at 30 days. The secondary end point was stroke rate per patient beyond 30 days. Success, dissection, restenosis, and occlusion rates were tracked.

RESULTS: From April 2002 to January 2009, 140 subjects with 159 lesions (50%–100% stenosis) underwent 209 interventions: 89 angioplasty, 47 BMS, and 73 WS cases. Overall stroke rate at 30 days was 12.9%. The angioplasty arm had the lowest stroke rate (4.5%), whereas the WS arm had the highest (24.7%; P = .0002), leaving the BMS with 10.7%. Stroke rate beyond 30 days was 9%. The success rate was 58.4% for angioplasty, 81.3% for BMS, and 94.4% for WS, whereas the restenosis rates were 28.2%, 5.8%, and 13.3%, respectively. Dissection increased the risk of stroke in the first 30 days ( P = .0439) and restenosis ( P = .0051). Perforator vessels were more likely than nonperforators to have stroke within 30 days ( P = .008). Eccentric lesions were more likely to have stroke than concentric lesions ( P = .0726).

CONCLUSIONS: In this comparison, angioplasty had a significantly lower stroke rate than WS. Certain lesion locations, morphologic characteristics, and the presence of dissection after treatment were other predictors of unfavorable outcome.

ACA
:   anterior cerebral artery
BA
:   basilar artery
BMC-IRR
:   Borgess Medical Center-Intracranial Revascularization Registry
BMS
:   balloon-mounted stent
DCA
:   diagnostic cerebral angiogram
DES
:   drug-eluting stent
ICA
:   internal carotid artery
IRB
:   Institutional Review Board
MCA
:   middle cerebral artery
mRS
:   modified Rankin Scale
TIA
:   transient ischemic attack
VA
:   vertebral artery
VBJ
:   vertebrobasilar junction
WASID
:   Warfarin-Aspirin Symptomatic Intracranial Disease
WS
:   wingspan stent system" />
<meta name="og-title" property="og:title" content="Predictors of Unfavorable Outcome in Intracranial Angioplasty and Stenting in a Single-Center Comparison: Results from the Borgess Medical Center-Intracranial Revascularization Registry" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/32/7/1221" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Intracranial angioplasty and stent placement are used to treat intracranial atherosclerotic disease. The 2 interventions have not been directly compared.

MATERIALS AND METHODS: This was a single-center, single-operator registry of consecutive, symptomatic subjects receiving treatment (angioplasty, BMS, or WS, chosen based on safety as judged by the operator). After November 2005, angioplasty alone was abandoned following the introduction of the WS. The primary end point was stroke rate per intervention at 30 days. The secondary end point was stroke rate per patient beyond 30 days. Success, dissection, restenosis, and occlusion rates were tracked.

RESULTS: From April 2002 to January 2009, 140 subjects with 159 lesions (50%–100% stenosis) underwent 209 interventions: 89 angioplasty, 47 BMS, and 73 WS cases. Overall stroke rate at 30 days was 12.9%. The angioplasty arm had the lowest stroke rate (4.5%), whereas the WS arm had the highest (24.7%; P = .0002), leaving the BMS with 10.7%. Stroke rate beyond 30 days was 9%. The success rate was 58.4% for angioplasty, 81.3% for BMS, and 94.4% for WS, whereas the restenosis rates were 28.2%, 5.8%, and 13.3%, respectively. Dissection increased the risk of stroke in the first 30 days ( P = .0439) and restenosis ( P = .0051). Perforator vessels were more likely than nonperforators to have stroke within 30 days ( P = .008). Eccentric lesions were more likely to have stroke than concentric lesions ( P = .0726).

CONCLUSIONS: In this comparison, angioplasty had a significantly lower stroke rate than WS. Certain lesion locations, morphologic characteristics, and the presence of dissection after treatment were other predictors of unfavorable outcome.

ACA
:   anterior cerebral artery
BA
:   basilar artery
BMC-IRR
:   Borgess Medical Center-Intracranial Revascularization Registry
BMS
:   balloon-mounted stent
DCA
:   diagnostic cerebral angiogram
DES
:   drug-eluting stent
ICA
:   internal carotid artery
IRB
:   Institutional Review Board
MCA
:   middle cerebral artery
mRS
:   modified Rankin Scale
TIA
:   transient ischemic attack
VA
:   vertebral artery
VBJ
:   vertebrobasilar junction
WASID
:   Warfarin-Aspirin Symptomatic Intracranial Disease
WS
:   wingspan stent system" />
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      <h1 class="highwire-cite-title" id="page-title">Predictors of Unfavorable Outcome in Intracranial Angioplasty and Stenting in a Single-Center Comparison: Results from the Borgess Medical Center-Intracranial Revascularization Registry</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">F. Al-Ali</span>, <span class="highwire-citation-author" data-delta="1">T. Cree</span>, <span class="highwire-citation-author" data-delta="2">S. Hall</span>, <span class="highwire-citation-author" data-delta="3">S. Louis</span>, <span class="highwire-citation-author" data-delta="4">K. Major</span>, <span class="highwire-citation-author" data-delta="5">S. Smoker</span> and <span class="highwire-citation-author" data-delta="6">S. Walker</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2011,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1221-1226; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2530 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-11402--6128616163" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">F. Al-Ali </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BAl-Ali%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Al-Ali%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AF.%2BAl-Ali%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">T. 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<p id="p-4"><strong>BACKGROUND AND PURPOSE:</strong> Intracranial angioplasty and stent placement are used to treat intracranial atherosclerotic disease. The 2 interventions have not been directly compared.</p>
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<p id="p-5"><strong>MATERIALS AND METHODS:</strong> This was a single-center, single-operator registry of consecutive, symptomatic subjects receiving treatment (angioplasty, BMS, or WS, chosen based on safety as judged by the operator). After November 2005, angioplasty alone was abandoned following the introduction of the WS. The primary end point was stroke rate per intervention at 30 days. The secondary end point was stroke rate per patient beyond 30 days. Success, dissection, restenosis, and occlusion rates were tracked.</p>
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<p id="p-6"><strong>RESULTS:</strong> From April 2002 to January 2009, 140 subjects with 159 lesions (50%–100% stenosis) underwent 209 interventions: 89 angioplasty, 47 BMS, and 73 WS cases. Overall stroke rate at 30 days was 12.9%. The angioplasty arm had the lowest stroke rate (4.5%), whereas the WS arm had the highest (24.7%; <em>P</em> = .0002), leaving the BMS with 10.7%. Stroke rate beyond 30 days was 9%. The success rate was 58.4% for angioplasty, 81.3% for BMS, and 94.4% for WS, whereas the restenosis rates were 28.2%, 5.8%, and 13.3%, respectively. Dissection increased the risk of stroke in the first 30 days (<em>P</em> = .0439) and restenosis (<em>P</em> = .0051). Perforator vessels were more likely than nonperforators to have stroke within 30 days (<em>P</em> = .008). Eccentric lesions were more likely to have stroke than concentric lesions (<em>P</em> = .0726).</p>
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<p id="p-7"><strong>CONCLUSIONS:</strong> In this comparison, angioplasty had a significantly lower stroke rate than WS. Certain lesion locations, morphologic characteristics, and the presence of dissection after treatment were other predictors of unfavorable outcome.</p>
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</div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">ACA<span class="def-item-dt-sep"></span></dt><dd>anterior cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">BA<span class="def-item-dt-sep"></span></dt><dd>basilar artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">BMC-IRR<span class="def-item-dt-sep"></span></dt><dd>Borgess Medical Center-Intracranial Revascularization Registry<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">BMS<span class="def-item-dt-sep"></span></dt><dd>balloon-mounted stent<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">DCA<span class="def-item-dt-sep"></span></dt><dd>diagnostic cerebral angiogram<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">DES<span class="def-item-dt-sep"></span></dt><dd>drug-eluting stent<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">ICA<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">IRB<span class="def-item-dt-sep"></span></dt><dd>Institutional Review Board<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">MCA<span class="def-item-dt-sep"></span></dt><dd>middle cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">mRS<span class="def-item-dt-sep"></span></dt><dd>modified Rankin Scale<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">TIA<span class="def-item-dt-sep"></span></dt><dd>transient ischemic attack<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">VA<span class="def-item-dt-sep"></span></dt><dd>vertebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">VBJ<span class="def-item-dt-sep"></span></dt><dd>vertebrobasilar junction<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">WASID<span class="def-item-dt-sep"></span></dt><dd>Warfarin-Aspirin Symptomatic Intracranial Disease<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">WS<span class="def-item-dt-sep"></span></dt><dd>wingspan stent system</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-2">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/32/7/1221.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Al-Ali</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Cree</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Hall</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Louis</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Major</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Smoker</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Walker</span></span></span></div>
  
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      <div class="highwire-cite-title">Predictors of Unfavorable Outcome in Intracranial Angioplasty and Stenting in a Single-Center Comparison: Results from the Borgess Medical Center-Intracranial Revascularization Registry</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Al-Ali</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Cree</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Hall</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Louis</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Major</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Smoker</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Walker</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2011, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">32 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1221-1226; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2530 </span></div>
  
  
  
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