Stenting for Symptomatic Severe Intracranial Arterial Stenosis with Downstream Perfusion Deficit in Anterior Circulation: A Retrospective Propensity-Matched Study.

Purpose: The purpose of this study is to investigate whether patients with symptomatic severe intracranial atherosclerotic stenosis (ICAS) and downstream perfusion deficit could benefit from adding percutaneous transluminal angioplasty and stenting (PTAS) to medical therapy.

Materials and methods: We retrospectively reviewed patients with symptomatic severe ICAS and an Alberta Stroke Program Early CT score of < 6 on mean transit time map who received either medical plus PTAS therapy (PTAS group) or medical therapy alone (medical group) between January 2016 and December 2019 at a single center. After 1:1 propensity score matching, we analyzed the primary outcome-cumulative event rate (defined as ischemic stroke in the qualifying artery)-along with four secondary outcomes (any intracranial hemorrhage within 30 days; disabling stroke or death; any stroke, transient ischemic attack, or cardiovascular events; and death by the end of follow-up).

Results: A total of 145 patients (79 in the PTAS group, 66 in the medical group) were included. After PSM, during a median follow-up of 43 months, the cumulative event rate was significantly lower in the PTAS group (11.6% [5/43]) than in the medical group (34.9%[15/43]; hazard ratio:0.35; 95%CI:0.15-0.85; P = 0.034). No significant difference was found for the primary outcome of ischemic stroke within 30 days or 1, 2, and 3 years, or for other secondary outcomes.

Conclusions: PTAS combined with medical therapy was associated with a lower probability of ischemic stroke over three years of follow-up than medical therapy alone. These findings should be interpreted with caution due to the study's retrospective design and single-center setting.