Introduction: Angioplasty and intracranial stenting (ICS) are both endovascular revascularization procedures that have emerged as treatment options for intracranial atherosclerotic disease (ICAD). Some have suggested that angioplasty alone is an alternative to angioplasty with ICS. The role of these procedures for treatment of ICAD, however, remains unclear. This study examines recent trends in utilization and outcomes of angioplasty alone and ICS in the United States using a population-based cohort.
Methods: The National Inpatient Sample (NIS) database was queried for patients with ICAD who underwent angioplasty or ICS from 2005-2010. Patient demographics, characteristics, perioperative complications and discharge data were collected.
Results: During 2005-2010, the NIS captured 1,115 patients (angioplasty: n = 495, ICS: n = 620) with ICAD underwent endovascular revascularization. Over time, the total number of endovascular revascularization procedures increased. There was an increase in the percentage of symptomatic patients (p = 0.015) as well as in the number of comorbidities of patients treated (p < 0.001). Combined post-procedure stroke and death rates were 16% and 28.9% for angioplasty and ICS, respectively (p<0.001). Comparing by procedure, a larger percentage of angioplasty patients presented symptomatically compared to those who underwent ICS (p<0.001).
Conclusions: Although both angioplasty and ICS experienced an increase in utilization over time, the increase in utilization of ICS surpassed that of angioplasty. Angioplasty appears to be associated with higher rates of peri-procedural complications; however, that may represent patient selection bias. Further studies are needed to identify patients who would benefit from revascularization and to clarify the roles of angioplasty and ICS.
Patient Care: The ideal management of patients with ICAD cannot yet be defined. There still remain cohorts of patients, specifically patients who have failed aggressive medical management, where not enough evidence is available to dictate decision-making. By identifying recent trends in utilization and outcomes of endovascular revascularization procedures for ICAD, our study helps improve patient care by providing a framework for the much needed trials to further elucidate the safety and efficacy of these procedures and their role in management of patients with ICAD.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe and discuss in small groups the national trends in utilization and outcomes of endovascular revascularization procedures for ICAD, and 2) Identify treatment options, both endovascular and alternative, for ICAD.