National trends in utilization and outcomes of angioplasty and stenting for revascularization in intracranial stenosis

Abstract

Introduction: Angioplasty and intracranial stenting (ICS) are both endovascular revascularization procedures that have emerged as treatment options for intracranial atherosclerotic disease (ICAD). Some believe angioplasty alone is better, while others believe stenting is better. 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 to 2010.

Results: There were 1115 patients (angioplasty: n=495, ICS: n=620) with ICAD who underwent endovascular revascularization. Over time, the number of endovascular revascularization procedures increased. The percentage of symptomatic patients (p=0.015) as well as in the number of comorbidities of patients treated (p<0.001) also increased. Combined post-procedure stroke and death rates were 16% and 28.9% for angioplasty and ICS, respectively (p<0.001). A larger percentage of angioplasty patients presented symptomatically compared to those who underwent ICS (p<0.001).

Conclusion: 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.

Keywords: Angioplasty; ICAD; ICS; Intracranial atherosclerosis disease; Intracranial stenosis; Intracranial stenting; National Inpatient Sample database; intracranial atherosclerotic disease; intracranial stenting.