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Original research
Lesion stability characteristics outperform degree of stenosis in predicting outcomes following stenting for symptomatic intracranial atherosclerosis
  1. M D Alexander1,
  2. D L Cooke2,
  3. P M Meyers3,
  4. M R Amans2,
  5. C F Dowd2,4,
  6. V V Halbach2,4,
  7. R T Higashida2,4,
  8. S W Hetts2
  1. 1Department of Radiology, University of Washington, Seattle, Washington, USA
  2. 2Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
  3. 3Departments of Radiology and Neurological Surgery, Columbia University, New York, New York, USA
  4. 4Departments of Neurological Surgery, Neurology, Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Matthew D Alexander, Department of Radiology, University of Washington, 1959 NE Pacific Street, Department of Radiology, Seattle, WA 98115, USA; matthew.alexander{at}caa.columbia.edu

Abstract

Background Intracranial atherosclerotic disease (ICAD) causes substantial morbidity and mortality. Treatment decisions have most commonly been driven by the degree of luminal stenosis. This study compares ICAD lesion stability features with percentage stenosis for associations with adverse outcomes following treatment with stents.

Materials and methods Retrospective analysis was performed of prospectively maintained procedure logs. Lesions were classified by symptom type as hypoperfusion, non-hypoperfusion, or indeterminate, and pretreatment asymptomatic intervals were noted. Hypoperfusion lesions and indeterminate or non-hypoperfusion lesions with ≥14 days of asymptomatic interval were classified as stable. Percentage stenosis was calculated and compared against these other symptom features for value in predicting technical complication, ischemic stroke, disability, or death at 90 days and 2 years using univariate and multivariate analysis.

Results 130 lesions were treated in 124 patients. The only statistically significant percent stenosis finding was lesions with 60–99% stenosis were less likely to have technical complications. In univariate analysis, stroke at 2 years was less common with hypoperfusion and stable lesions. In multivariate analysis, only hypoperfusion status was associated with lower stroke rates at 2 years.

Conclusions Lesion stability features, particularly non-hypoperfusion symptomatology, outperform percentage stenosis in predicting outcomes following treatment of ICAD with stents. Further examination is needed to better classify the natural history of ICAD and more precisely classify lesion stability.

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