Current Status of Endovascular Therapy for Intracranial Artery Stenosis from the Results of a Nationwide Survey

Objective: The purpose of this study was to investigate the current status of treatment for intracranial artery stenosis (ICAS) in Japan. Methods: A questionnaire was administered to a member of the Japanese Society for Neuroendovascular Therapy (JSNET), and data regarding the number of treatments for ICAS and the treatment strategies employed were collected via e-mail. Results: Responses were received from 261 hospitals (25.8%) with JSNET members. From January 1 to December 31, 2017, the number of endovascular treatments for ICAS was 783. Among them, symptomatic lesions were seen in 89.8% of the cases, and 30.3% of ICAS cases were diagnosed after the reperfusion of an acute occlusion. Among the treatment strategies for ICAS detected after the reperfusion of an acute large-vessel occlusion (ALVO), antiplatelet therapy was utilized in 23.8% of cases and endovascular therapy was utilized in 70.4% of cases, in addition to antiplatelet therapy. In cases involving symptomatic severe ICAS resistant to medical treatment with cerebral blood flow (CBF) impairment, 97.8% of physicians suggested intervention. However, in cases without CBF impairment, the percentage of physicians who suggested intervention decreased to 53.1%. In contrast, for asymptomatic ICAS without CBF impairment, more than 95% of physicians selected medical treatment. Conclusion: In cases involving symptomatic ICAS resistant to medical treatment with CBF impairment, the rate of physicians who suggested intervention was quite high in Japan. Thirty percent of ICAS cases were diagnosed after the reperfusion of an ALVO.