Efficacy and safety of endovascular treatment in young patients with symptomatic intracranial atherosclerotic stenosis: comparison with medical treatment alone
10.3760/cma.j.issn.1673-4165.2025.06.006
- VernacularTitle:血管内治疗在青年有症状颅内动脉粥样硬化性狭窄患者中的有效性和安全性：与单纯药物治疗的比较
- Author:
Yuxiang ZHANG
1
;
Xi ZHANG
;
Lili HUANG
;
Yidan WANG
;
Yun LUO
;
Yun XU
;
Jingwei LI
Author Information
1. 南京大学医学院附属鼓楼医院神经内科，南京 210008
- Keywords:
Intracranial arteriosclerosis;
Constriction, pathologic;
Ischemic stroke;
Ischemic attack, transient;
Endovascular procedures;
Angioplasty, balloon;
Stents
- From:
International Journal of Cerebrovascular Diseases
2025;33(6):435-441
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of endovascular treatment (EVT) in young patients with symptomatic intracranial atherosclerotic stenosis (sICAS).Methods:Young patients with sICAS admitted to the Department of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University, Medical School from January 2020 to July 2024 were included retrospectively. According to the therapeutic modalities, they were divided into a best medical treatment (BMT) group and an EVT group. The efficacy outcome was any stroke recurrence or death within 30 days and 1 year. The safety outcome was symptomatic intracranial hemorrhage (sICH) within 30 days and restenosis within 1 year.Results:A total of 113 patients were enrolled, including 85 males (75.2%), with a median age of 43 (interquartile range, 37-48) years; 44 patients (38.9%) received EVT, and 69 (61.1%) received BMT. Among the 44 patients who underwent EVT, 8 (18.2%) underwent balloon angioplasty and 36 (81.8%) underwent stenting. There was no significant difference in the incidence of stroke recurrence or death within 30 days (2.9% vs. 2.3%) and sICH incidence (0% vs. 2.3%) between the BMT group and the EVT group. However, the 1-year stroke recurrence or death rate in the EVT group was significantly lower than that in the BMT group (18.8% vs. 4.5%; P=0.029). Cox proportional hazards regression analysis showed that EVT was independently associated with a lower incidence of stroke recurrence or death within 1 year (hazard ratio 0.225, 95% confidence interval 0.051-0.996; P<0.05). The median age of the balloon angioplasty group was significantly lower than that of the stenting group (33.5 years vs. 46 years; P=0.007), while there were no significant differences in other demographic and baseline data. There was no significant difference in all efficacy and safety outcome between the balloon angioplasty group and the stenting group. Conclusions:For young patients with sICAS who have an unsatisfactory response to drug treatment, EVT can reduce the risk of stroke recurrence or death within 1 year without increasing the risk of sICH. The safety and efficacy of balloon angioplasty and stenting are similar.
