Intracranial stenting after an initial ischemic stroke may decrease risk of recurrent stroke more than use of aspirin or warfarin, according to a presentation at International Stroke Conference 2007.

Previous studies showed that despite anticoagulation treatment, patients with symptomatic intracranial atherosclerotic stenosis had an 11 percent increased risk of ischemic stroke in the area near the blockage after one year and a 14 percent increased risk after two years.

In the current study, Chinese researchers investigated long-term outcomes of intracranial stenting and explored factors associated with subsequent stroke. Intracranial stenting is a minimally invasive procedure that inserts a stent pre-mounted on a balloon. After the stent is placed, the balloon is removed without having been expanded.

“Commonly, the stenosis is 50 percent or more,” said Wei-Jian Jiang, MD, lead author of the study at Beijing Tiantan Hospital in China. “Intracranial atherosclerosis is an important cause of ischemic stroke that is more common among Asians, Hispanics and blacks.”

Researchers reviewed medical data on 213 people (176 men, 37 women; average age, 53 years) who had stroke or transient ischemic attack resulting from intracranial stenosis and underwent stenting in a brain artery to improve blood flow to affected regions of the brain.

Within 30 days of stenting, 10 of 213 had strokes - the primary endpoint. Seven had ischemic strokes and three had hemorrhagic strokes. Another nine patients had a secondary endpoint event: seven had emergent cerebral revascularization and two had asymptomatic intracranial hemorrhage.

Researchers followed 198 patients who did not have a stroke within the first 30 days. During a median follow-up of about two years, seven had ischemic stroke in the area of the stenting, whereas three had ischemic stroke in a different area.

This study shows that ischemic stroke risk in the area of stenting (including stroke within 30 days) was just 6.9 percent after one year and 8.9 percent after two years.

“Our study shows a better long-term outcome of patients with symptomatic atherosclerotic stenosis after elective stenting,” Jiang said.

However, he said blockages that were difficult to access and diabetes increased the risk of subsequent stroke in the area around the stent.

Intracranial stenting is still an investigational procedure. Some high-risk patients - those not helped by medical therapy, those who have severe stenosis (greater than 70 percent blockage), and patients who have brain imaging that shows a lack of blood flow through an area of the brain can be referred to an interventional neuroradiologist.

The referrals should be to a doctor highly experienced with the procedure, “because intracranial stenting itself may lead to a stroke, even death, and a high rate of procedural complication can offset the potential benefits,” Jiang said.