• Amin Aghaebrahim, Guilherme Jose Agnoletto, Pedro Aguilar-Salinas, Manuel F Granja, Andre Monteiro, Adnan H Siddiqui, Elad I Levy, Hussain Shallwani, Song J Kim, Diogo C Haussen, Raul G Nogueira, Demetrius Lopes, Ahmed Saied, Tudor G Jovin, Ashutosh P Jadhav, Kaustubh Limaye, Aquilla S Turk, Alejandro M Spiotta, Mohammad I Chaudry, Raymond D Turner, Brasiliense Leonardo B C LBC Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA., Travis M Dumont, Jacob Cherian, Peter Kan, Eric Sauvageau, and Ricardo A Hanel.
• Lyerly Neurosurgery/Baptist Health, Baptist Neurological Institute, Jacksonville, Florida, USA. Electronic address: Amin.Aghaebrahim@bmcjax.com.
• World Neurosurg. 2019 Mar 1; 123: e693-e699.

BackgroundThe optimal management of intracranial arterial stenosis is unclear, particularly in patients who have failed medical management. We report a multicenter real-world experience of endovascular recanalization of intracranial atherosclerotic stenosis refractory to aggressive medical therapy.MethodsRetrospective multicenter case series of consecutive endovascularly treated patients presenting with symptomatic (transient ischemic attack [TIA] or stroke) intracranial stenosis who had failed medical therapy. Patients were divided into 2 groups: patients with recurrent TIA or stroke despite medical management (group 1) versus patients presenting with a stroke and worsening symptoms (progressive or crescendo stroke) despite medical management (group 2).ResultsA total of 101 patients were treated in 8 stroke centers from August 2009 to May 2017. Sixty-nine presented with recurrent TIA or stroke and 32 with stroke and worsening symptoms. Successful recanalization was achieved in 84% of patients. Periprocedural stroke occurred in 3 patients and 2 had a recurrent ischemic stroke at the 90-day follow-up. Symptomatic intraparenchymal hemorrhage secondary to reperfusion injury occurred in 3 patients and 1 had a hemorrhagic stroke after discharge. There were 2 periprocedural perforations that resulted in death. At 90 days, 86% of patients (64/74) did not have a recurrence of stroke and the 90-day cumulative ischemic stroke rate was 6.7% with 90-day mortality of 11.2%. The 90-day favorable outcome (modified Rankin Scale score, ≤2) rate was 77.5%.ConclusionsEndovascular recanalization of unstable intracranial atherosclerotic stenosis in patients who have failed medical therapy is feasible. Future randomized trials need to determine if recanalization is of any value for this population.Copyright © 2018 Elsevier Inc. All rights reserved.

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