Balloon angioplasty lowers risk for composite outcome in intracranial artery stenosis

For patients with symptomatic intracranial atherosclerotic stenosis (sICAS), balloon angioplasty plus aggressive medical management is associated with a lower risk for a composite outcome of any stroke or death, according to a study published online Sept. 5 in the Journal of the American Medical Association.

Xuan Sun, M.D., from Capital Medical University in Beijing, and colleagues conducted a randomized clinical trial involving patients aged 35 to 80 years with sICAS, defined as recent transient ischemic attack (<90 days) or ischemic stroke (14 to 90 days). Participants were randomly allocated to submaximal balloon angioplasty plus aggressive medical management or aggressive medical management alone (249 and 252 individuals, respectively).

The researchers found that the incidence of the primary outcome, a composite of any stroke or death within 30 days after enrollment or any ischemic stroke after 30 days through 12 months after enrollment, occurred in 4.4 and 13.5 percent of patients in the balloon angioplasty and medical management groups, respectively (hazard ratio, 0.32). The corresponding rates of any stroke or all-cause death within 30 days were 3.2 and 1.6 percent. The rates of any ischemic stroke in the qualifying artery territory were 0.4 and 7.5 percent, respectively, and revascularization of the qualifying artery occurred in 1.2 and 8.3 percent, respectively, beyond 30 days and through 12 months after enrollment.

"Balloon angioplasty plus aggressive medical management may be an effective treatment for sICAS, although the risk of stroke or death within 30 days of balloon angioplasty should be considered in clinical practice," the authors write.

Several authors disclosed ties to the biopharmaceutical and medical device industries.

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