Primary Angioplasty Versus Stenting for Endovascular Management of Intracranial Atherosclerotic Disease Following Acute Ischemic Stroke.

Mark R Villwock, David J Padalino, Raghu Ramaswamy, Eric M Deshaies
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Abstract

Background: The future of neuroendovascular treatment for intracranial atherosclerotic disease (ICAD) has been debated since the results of SAMMPRIS reflected poor outcomes following endovascular therapy. There is currently a large spectrum of current management strategies. We compared historical outcomes of patients with ICAD and stroke that were treated with angioplasty-alone versus stent placement.

Methods: We extracted a population from the Nationwide Inpatient Sample (NIS) (2005-2011) and the National Inpatient Sample (NIS) (2012) composed of patients with ICAD and infarction that were admitted nonelectively and received endovascular revascularization. Patients treated with thrombectomy or thrombolysis were excluded. Categorical variables were compared with Chi-squared tests. Binary logistic regression was performed to evaluate mortality while controlling for age, sex, severity, and comorbidities.

Results: About 2059 admissions met our criteria. A majority were treated via stent placement (71%). Angioplasty-alone had significantly higher mortality (17.6% vs. 8.4%, P<0.001), but no difference in iatrogenic stroke rate (3.4% vs. 3.6%, P=0.826), compared to stent placement. The adjusted odds ratio of mortality for stented patients was 0.536 (95% CI: 0.381-0.753, P<0.001) in comparison to patients treated with angioplasty alone.

Conclusions: This study found the risk of mortality to be elevated following angioplasty alone in comparison to revascularization with stent placement, without a corresponding significant difference in iatrogenic stroke rate. This may represent selection bias due to patient characteristics not defined in the database, but it also may indicate that patients with ICAD and acute stroke have increased odds of stenosis that is refractory to angioplasty alone and have a high risk of mortality without revascularization.

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急性缺血性脑卒中后颅内动脉粥样硬化性疾病血管内治疗的初步血管成形术与支架植入术。
背景:神经血管内治疗颅内动脉粥样硬化性疾病(ICAD)的未来一直存在争议,因为SAMMPRIS的结果反映了血管内治疗后的不良结果。目前有各种各样的管理策略。我们比较了单独接受血管成形术与支架置入术治疗的ICAD和卒中患者的历史结果。方法:我们从全国住院患者样本(NIS)(2005-2011年)和全国住院患者样本(NIS)(2012年)中提取人群,由非选择性入院并接受血管内血运重建术的ICAD和梗死患者组成。排除接受取栓或溶栓治疗的患者。分类变量比较采用卡方检验。在控制年龄、性别、严重程度和合并症的情况下,采用二元逻辑回归来评估死亡率。结果:约2059例符合标准。大多数患者通过支架置入治疗(71%)。单独血管成形术的死亡率明显更高(17.6% vs. 8.4%)。结论:本研究发现,单独血管成形术与支架置入术相比,死亡率风险升高,但在医源性卒中发生率方面没有相应的显著差异。这可能代表了由于数据库中未定义的患者特征而导致的选择偏差,但也可能表明,ICAD和急性卒中患者发生血管成形术难愈的狭窄的几率增加,并且在没有血管重建术的情况下死亡的风险很高。
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