Background and purpose A recent randomized controlled trial demonstrated that aggressive medical management was superior to angioplasty with stenting for intracranial stenosis. The purpose of this study is to assess initial and long-term outcomes of balloon angioplasty without stenting for symptomatic middle cerebral artery (MCA) stenosis.

Methods We retrospectively analyzed the clinical data of 72 patients (mean age; 58.9 years old) with 84 balloon angioplasties without stenting for high-grade (and >70%) atherosclerotic stenosis of the main trunk of the MCA. All patients had experienced recurrent transient ischemic attack (TIA) or minor stroke resistant to medical treatment. We assessed perioperative and long-term outcomes such as restenosis and the recurrence of strokes. The follow-up period was a median of 63 months (range 6–171 months).

Results Balloon angioplasty was successfully 97% of procedures. During the 30 day perioperative period, a total of 3 patients suffered a stroke (4.2%) without death. A total of 23 (31.9%) patients had restenosis at a time-point that varied from 6–111 months. Diabetes mellitus was noted significantly more often in the restenosis group (39%) than in non-restenosis group (13%). Multivariate logistic regression analysis revealed diabetes mellitus (OR, 4.84; 95% CI, 1.196–19.62, p=0.027) as an independent predictor of restenosis. Restenosis and diabetes mellitus were indicated as independent predictors of recurrence of ischemic stroke and TIA.

Conclusions Balloon angioplasty without stenting for symptomatic MCA stenosis can be performed with a high successful rate and a low risk of complications. Long-term outcome data suggest that this procedure reduces the risk of further strokes.

Disclosures T. Ueda: None. T. Takada: None. S. Takaishi: None. T. Fukano: None. K. Tatsuno: None. T. Yoshie: None.