Angioplasty and Stenting for Patients With Symptomatic Intracranial Atherosclerosis

Background: Effectiveness of Percutaneous transluminal angioplasty and stenting (PTAS) on prevention of events of stroke and death in patients with symptomatic intracranial atherosclerosis (ICAS) is controversial.

Aim: to determine whether PTAS plus medical treatment (MT) are superior to MT alone in preventing events of stroke and death in patients with symptomatic ICAS.

Methods: The investigators will carry out a randomized controlled trial in 3 hospitals in China. A total of 198 patients with ICAS will be randomized into 2 groups: PTAS+MT and MT group. All patients will receive aspirin (100 mg daily) and clopidogrel (75 mg daily) immediately after randomization, and patients in PTAS+MT group will receive surgery within 5 days after randomization. The patients will be followed up for 1 year after randomization and assessed for events of stroke and death at 30 days and 1 year after randomization, the incidence of recurrent ischaemic stroke in the stenting-involved vascular territory at 30 days and 1 year after randomization, incidence of in-stent restenosis at 1 year after randomization,etc.


Eligibility Criteria:
Inclusion Criteria:

* Patients aged from 18 to 70 years.
* Complaints of a Symptomatic ICAS: a history of recurrent transient ischemic attacks or an ischemic stroke within 1 year owing to a 70%-99% stenosis in an internal carotid artery, middle cerebral artery, vertebral artery, or basilar artery.
* A length ≤ 15mm of a stenosis in the target vessel and a vessel size \>2.5mm.
* Hypoperfusion in the territory of the target vessels, which is determined by CT or MRI in 14 days before stenting.
* CT or MRI scans show no massive cerebral infarction (beyond half of the territory of middle cerebral artery (MCA)), intracranial hemorrhage, epidural or sub-dural hemorrhage, and intracranial brain tumor.
* Patients who understand the purpose of the study and have provided informed consent.

Exclusion Criteria:

* Not able to receive general anesthesia.
* Not able to receive angiographic assessment.
* A stenosis \>50% in an extracranial carotid or vertebral artery on the ipsilateral side.
* Infarctions due to the perforators occlusion (determined by MRI scan), which is defined as basal ganglia or brainstem/thalamus infarction related with middle cerebral artery or basilar artery stenosis.
* A high risk (leading to a stroke or death) to deliver the stent to the lesion.
* A previous stent or angioplasty in the target lesion.
* Progressive neurological signs within 24 hours before enrolment
* Any haemorrhagic infarct within 14 days before enrolment
* The presence of a cardiac source of embolus
* Thrombolytic therapy within 24 hours before enrollment
* Presence of intraluminal thrombus proximal to or at the target lesion
* Myocardial infarction within previous 30 days
* Non-atherosclerotic lesions: arterial dissection, moya-moya disease; vasculitic disease; herpes zoster, varicella zoster or other viral vasculopathy; neurosyphilis; any other intracranial infection; any intracranial stenosis associated with cerebrospinal fluid pleocytosis; radiation-induced vasculopathy; fibromuscular dysplasia; sickle cell disease; neurofibromatosis; benign angiopathy of central nervous system; postpartum angiopathy; suspected vasospastic process, and suspected recanalized embolus.
* Known contraindications for aspirin and clopidogrel treatment.
* An modified Rankin scale≥3.
* With a childbearing potential or a positive pregnancy test in 1 week before enrolment.