Management Strategies in Posterior Circulation Intracranial Atherosclerotic Disease

Abstract

Purpose:

To assess the short-term prognosis of patients with recent symptomatic intracranial atherosclerotic disease in the posterior circulation and evaluate differences in the outcome of patients receiving medical or endovascular treatment.

Methods:

The records of 50 consecutive patients with symptomatic intracranial atherosclerotic disease in the posterior circulation were reviewed to record the occurrence of transient ischemic attack, stroke, major bleeding, and/or death during the 12-month period following a neurological event. Twenty-five patients received medical treatment alone, 13 initially received medical treatment and subsequently were treated with angioplasty/stenting due to recurrent events (analyzed in both groups), and 12 patients received endovascular treatment initially. The crossover patients were considered as 1 treated patient in each group; thus, there were 38 subjects (33 men; mean age 68±9 years) receiving medical therapy compared with 25 patients (21 men; mean age 63± 13 years) who underwent endovascular procedures.

Results:

During the 12-month period, subjects in the medically-treated group had a higher rate of events (37%, 14/38) than patients who received angioplasty/stenting (12%, 3/25; p=0.042). Notably, there were 7 (18%) TIAs and 6 (16%) strokes in medically-treated patients versus no TIAs (0%, p = 0.035) and only 2 (8%, p = NS) strokes in the endovascular group, both of which occurred within 48 hours of the procedure. There were no deaths and only a single major bleeding event in each group.

Conclusion:

Endovascular treatment of patients with symptomatic intracranial disease of the posterior territory appears to be associated with a substantially better outcome.