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. 2014 Dec 11:5:178.
doi: 10.4103/2152-7806.146831. eCollection 2014.

Comparison of outcomes and utilization of extracranial-intracranial bypass versus intracranial stenting for intracranial stenosis

Taylor A Wilson  1 , Omar Tanweer  1 , Paul P Huang  1 , Howard A Riina  1
Affiliations

Comparison of outcomes and utilization of extracranial-intracranial bypass versus intracranial stenting for intracranial stenosis

Taylor A Wilson et al. Surg Neurol Int. .

Abstract

Background: Extracranial-intracranial (EC-IC) bypass and intracranial stenting (ICS) are both revascularization procedures that have emerged as treatment options for intracranial atherosclerotic disease (ICAD). This study describes and compares recent trends in utilization and outcomes of intracranial revascularization procedures in the United States using a population-based cohort. It also investigates the association of ICS and EC-IC bypass with periprocedural morbidity and mortality, unfavorable discharge status, length of stay (LOS), and total hospital charges.

Methods: The National Inpatient Sample (NIS) was queried for patients with ICAD who underwent EC-IC bypass or ICS during the years 2004-2010. Patient characteristics, demographics, perioperative complications, outcomes, and discharge data were collected.

Results: There were 627 patients who underwent ICS and 249 patients who underwent EC-IC bypass. Patients who underwent ICS were significantly older (P < 0.001) with more comorbidities (P = 0.027) than those who underwent EC-IC bypass. Patients who underwent EC-IC bypass experienced higher rates of postprocedure stroke (P = 0.014), but those who underwent ICS experienced higher rates of death (P = 0.006). Among asymptomatic patients, the rates of postprocedure stroke (P = 0.341) and death (P = 0.887) were similar between patients who underwent ICS and those who underwent EC-IC bypass. Among symptomatic patients, however, there was a higher rate of postprocedure stroke in patients who underwent EC-IC bypass (P < 0.001) and a higher rate of death among patients who underwent ICS (P = 0.015).

Conclusion: The ideal management of patients with ICAD cannot yet be defined. Although much data from randomized and prospective trials on revascularization have been collected, many questions remain unanswered. There still remain cohorts of patients, specifically patients who have failed aggressive medical management, where not enough evidence is available to dictate decision-making. In order to further elucidate the safety and efficacy of these intracranial revascularization procedures, further clinical trials are needed.

Keywords: Extracranial–intracranial bypass; National inpatient sample database; intracranial atherosclerotic disease; intracranial stenosis; intracranial stenting.

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Figures

Figure 1
Figure 1
Trends in utilization of intracranial stenting and extracranial–intracranial bypass procedures for revascularization of patients with intracranial stenosis
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