Treatment of high risk symptomatic intracranial atherosclerosis with balloon mounted coronary stents and Wingspan stents: single center experience over a 10 year period.

Abstract

BACKGROUND:

Stenting of symptomatic intracranial atherosclerosis remains under investigation, yet this option to potentially avert subsequent stroke has been offered at select centers under humanitarian device exemption and off-label use for several years.

METHODS:

Retrospective case series of consecutive patients undergoing stenting with Wingspan and balloon mounted coronary stents for symptomatic intracranial atherosclerosis at a single institution. Recurrent symptomatic ischemia in the territory of the stented artery was ascertained. Rates of recurrent ischemic stroke were calculated per patient-year of follow-up and were compared with medically treated patients in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial.

RESULTS:

During the 10 year study period, 41 cases of intracranial stenting were identified. Stenoses were severe (>70%) in 88% of patients. Stenting procedures occurred a median of 14 days from the most recent symptomatic event. 19 Wingspan stents and 22 balloon mounted coronary stents were deployed. Four strokes occurred within 24 h of stenting, seven within 1 month and eight within 3 months. By 3 months after stenting, no further strokes occurred during up to 2 years of follow-up. Patients had 0.194 ischemic strokes per person-year of follow-up, compared with 0.083 ischemic strokes per person-year of follow-up in the aspirin arm of WASID and 0.065 ischemic strokes per person-year of follow-up in the warfarin arm of WASID.

CONCLUSIONS:

Stenting of symptomatic intracranial atherosclerosis in a high risk subset of cases with advanced degree of luminal stenosis may be associated with an increased early risk of recurrent ischemic stroke.

• Authors: Nicholas Tarlov, Reza Jahan, Jeffrey L Saver, James W Sayre, Latisha K Ali, Doojin Kim, Gary R Duckwiler, Satoshi Tateshima, Fernando Viñuela, David S Liebeskind
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 4 Issue 1 Pg. 34-9 (Jan 01 2012) ISSN: 1759-8486 [Electronic] England
• PMID: 21990460 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Angioplasty, Balloon (instrumentation, methods)
• Carotid Stenosis (diagnosis, pathology, surgery)
• Coronary Vessels (pathology, surgery)
• Female
• Follow-Up Studies
• Humans
• Intracranial Arteriosclerosis (pathology, surgery)
• Male
• Middle Aged
• Randomized Controlled Trials as Topic (trends)
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Stents
• Treatment Outcome