Wingspan stenting for intracranial atherosclerotic stenosis: clinical outcomes and risk factors for in-stent restenosis.

Abstract

BACKGROUND:

Intracranial atherosclerotic stenosis (ICAS) is responsible for 9% to 37% of ischemic strokes.

OBJECTIVE:

To evaluate the clinical outcome and risk factors for in-stent restenosis (ISR) after treatment of ICAS with a Wingspan stent.

METHODS:

Seventy-seven patients with 79 total target ICAS > 60% (mean, 79.9 ± 8.4%; symptomatic ICAS, 96.2%) underwent attempted treatment with Wingspan stenting between March 2010 and March 2011. A retrospective review of the prospectively registered data was conducted to assess the risk factors for ISR and the clinical outcomes of these patients.

RESULTS:

The 30-day transient ischemic attack/stroke and death rates were 5.3% (95% confidence interval [CI], 0.1-10.5) and 0%, respectively. All patients but 1 were followed up clinically for a mean of 18.9 months (range, 12-23 months). During the period, cumulative transient ischemic attack/stroke and death rates were 8.1% (95% CI, 1.7-14.5) and 0%, respectively. Only 1 patient suffered a disabling stroke (subarachnoid hemorrhage), which was associated with retreatment of an ISR with a drug-eluting balloon-expandable stent. Follow-up angiography was available in 69 treated vessels (89.6%) at 3 to 24 months (median, 12 months). Binary ISR rate was 24.6%, of which 17.6% (3 of 17 cases) was symptomatic. Rapid balloon inflation (95% CI, 5.490-530.817) and longer length of stenosis (95% CI, 1.093-1.891) were independent risk factors for ISR.

CONCLUSION:

Wingspan stenting may be effective for appropriately selected ICAS patients. Rapid balloon inflation and longer lengths of stenosis were independent risk factors for ISR.

• Authors: Yong Sam Shin, Byung Moon Kim, Sang Hyun Suh, Pyoung Jeon, Dong Joon Kim, Dong Ik Kim, Bum-Soo Kim, Keon Ha Kim, Ji Hoe Heo, Hyo Suk Nam, Young Dae Kim
• Journal: Neurosurgery (Neurosurgery) Vol. 72 Issue 4 Pg. 596-604; discussion 604 (Apr 2013) ISSN: 1524-4040 [Electronic] United States
• PMID: 23277374 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aged, 80 and over
• Drug-Eluting Stents (adverse effects)
• Female
• Graft Occlusion, Vascular (diagnosis, epidemiology)
• Humans
• Intracranial Arteriosclerosis (diagnostic imaging, epidemiology, surgery)
• Male
• Middle Aged
• Prospective Studies
• Radiography
• Registries
• Retrospective Studies
• Risk Factors
• Treatment Outcome