listened again to Marc Chimowitz' presentation at AAN which is free and listed here: http://198.174.119.11/aan2008/viewer.php?pf=yhQrXc0MrAOPdFasxSXDMQ==&ud=I+ld1u1vbwERuUlz7ZfDxA== see slide 30.
Using the NIH wingspan registry, the 24 hour stroke or death rate after intracranial stenting is 6.2 % which is the number quoted by Alex previously. The 30 day risk is 9.6 % and the six month risk of ipsilateral stroke is 14 %. This is for intracranial stenosis. The risk of more than 50 % restenosis is not counted and that is 25 %. The technical success of the procedure is 96.7 %.Chimowitz compares the risk to wasid untreated patients wherein risk is in the low 20s for more strokes, although the risk stratifies to those with severe stenosis (more than 70%) and less than 30 days from a qualifying event. Therefore there is potential for benefit with intracranial stenting possibly around 8 % (NTT would be around 12.5). However, the conservative risk to quote to a patient is 14 % of complications in good hands with no data on direct benefit (since the trial head to head is not complete). That is because the late strokes are probably embolic, or due to restenosis and late failure. Presumably, the other 11 % of restenosis cases are asymptomatic. Based on my prior post, also, watch out that you don't stent the lenticulostriates (where is the stenosis, which part of the artery).
Again, Ron, my advice is to get the second event from a nontechnician and take the quoted data about risk with a grain of salt. Make a clinical decision based on your own experience and consideration.
Using the NIH wingspan registry, the 24 hour stroke or death rate after intracranial stenting is 6.2 % which is the number quoted by Alex previously. The 30 day risk is 9.6 % and the six month risk of ipsilateral stroke is 14 %. This is for intracranial stenosis. The risk of more than 50 % restenosis is not counted and that is 25 %. The technical success of the procedure is 96.7 %.Chimowitz compares the risk to wasid untreated patients wherein risk is in the low 20s for more strokes, although the risk stratifies to those with severe stenosis (more than 70%) and less than 30 days from a qualifying event. Therefore there is potential for benefit with intracranial stenting possibly around 8 % (NTT would be around 12.5). However, the conservative risk to quote to a patient is 14 % of complications in good hands with no data on direct benefit (since the trial head to head is not complete). That is because the late strokes are probably embolic, or due to restenosis and late failure. Presumably, the other 11 % of restenosis cases are asymptomatic. Based on my prior post, also, watch out that you don't stent the lenticulostriates (where is the stenosis, which part of the artery).
Again, Ron, my advice is to get the second event from a nontechnician and take the quoted data about risk with a grain of salt. Make a clinical decision based on your own experience and consideration.
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