Introduction/Purpose Intracranial stenosis and treatment remains controversial based on mixed reports of complication rates and varying results of medical treatment. We reviewed our series of intracranial angioplasty and stenting done only on symptomatic patients refractory to medical management to the SAMMPRIS trial and as a basis for quality improvement.
Materials and Methods A retrospective review of 42 sequential patients ranging from 29 to 86 years old (average 61) with symptomatic intracranial stenosis refractory to medical therapy and treated by angioplasty and stenting from December 2006 to March 2011 at our institution was undertaken. Four cases were not included in the analysis because of technical failure of stent placement.
Results Average presenting stenosis was 74.5% and residual 15.8% after angioplasty and stenting. The patients were followed for up to 3 years.
Of the patients who received angioplasty and stenting 8.8% (4 patients) died within 30 days, three from complications of the procedure (6.8%) and one six days later from supraventricular tachycardia and cardiac arrest associated with a pre-procedure myocardial infarction.
Three additional patients had strokes associated with their procedures for a total complication rate of (13.3%) and five cases have shown asymptomatic restenosis (11%) in the past 3 years.
Compared to the SAMMPRIS trial the overall complication rate is similar (13.3%) versus (14%) with a higher death rate (6.8%) versus (2.2%)
Analysis of our deaths found that two of the deceased patients had hypertensive spikes during extubation and subsequently deteriorated after initially being neurologically intact. One of these patients developed a basal ganglia haemorrhagic transformation (HI2) and went on to have a large ischaemic MCA infarct, the other a subarachnoid haemorrhage consistent with vessel rupture.
Conclusion We found that successful angioplasty and stenting can be performed in a nonacademic setting with similar complication rates to other reports. Choosing symptomatic patients that have failed aggressive medical management may account for our outcomes.
The two of the deaths in our series may be associated with complications from our anaesthesia care. We have since changed our protocol to have ongoing IV Bp and pain management during extubations.
Disclosures M. Parker: None. J. Yin: None. N. Rutledge: None. K. Conrad: None. B. Horowitz: None. J. Luci: None.
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