Endovascular treatment of symptomatic intracranial stenosis with the Wingspan stent system and Gateway PTA balloon: a multicenter series of 60 patients with acute and midterm results

Abstract

Object The limitations of the medical management of symptomatic intracranial arterial stenosis (SIAS) have encouraged the development of new strategies, such as endovascular treatment. In this study, the authors report and analyze a series of 63 endovascular procedures in which the Wingspan stent system was used. Methods Data from 60 patients presenting with refractory SIAS, treated in 5 French neurointerventional centers between September 2006 and August 2009, were retrieved. An angiogram was systematically obtained 6 months after the procedure and yearly thereafter. The clinical neurological status was assessed and reported using the modified Rankin scale at 1-month, 6-month, and 1-year follow-up visits. Results A total of 63 stenotic lesions was treated. The mean age of the patients was 65.3 years, and the mean diameter of the stenosis was 80.2%. Technical success was achieved in 95.2% of cases. The overall incidence of procedural complications was 20.6%, with a 4.8% rate of permanent postoperative morbidity and death. In-stent restenosis (ISR)/occlusion occurred in 11 cases (17.4%), of which 10 were asymptomatic and 9 were detected less than 1 year from the endovascular treatment. In 1 case, the patient presented with a recurrent transient ischemic attack and was treated again with angioplasty. The mean follow-up was 13.2 months. Conclusions Endovascular treatment of SIAS demonstrates a moderate risk of neurological complication. Nevertheless, considering the critical natural history of severe refractory lesions, this may be considered the first alternative in cases of failed medical therapy. Technical failure, residual stenosis, or in-stent restenosis did not lead to systematic recurrent stroke in this series, which suggests the importance of plaque stabilization and neoendothelialization.

Stenting of symptomatic intracranial stenosis using balloon mounted coronary stents: a single center experience

“…Our overall morbidity of 9.5% with an average clinical follow-up time of 32.1±24.5 months is similar to the average reported overall morbidity of 8.8% in 282 patients (range 7–9.8%) reported in the literature 11 15. The overall morbidity following Wingspan placement was 19.4% in 431 patients (range 7.1–23%), as reported in the literature 2 12 14 16. As a comparison, patients in the SAMMPRIS trial who were treated with aggressive medical therapy continued to have strokes well beyond the 30 day time period.…”

“…This rate is within the range of restenosis reported in the literature following BMCS placement (12.5–20.2%) and Wingspan placement (17.4–34.5%) 3 10 13 14 16 17. In three cases, the hyperplasia stabilized and the patients remained asymptomatic.…”

Role of Stenting for Intracranial Atherosclerosis in the Post-SAMMPRIS Era

“…Nonetheless, 12 of the 19 ICAD stenting studies we reviewed used the Wingspan. Seven studies used the Wingspan stent exclusively comprising 377 patients with 402 lesions [17, 19, 20, 25, 27, 30, 32]. The median minimum stenosis was 70% (range 50–70%) which was the same cutoff used in SAMMPRIS.…”

Optimization of MR Parameters of 3D TOF-MRA for Various Intracranial Stents at 3.0T MRI

“…However, these stents cause endothelial hyperplasia, and thrombosis that might cause significant stenosis or occlusion of stented arteries [6]. Thus, it is important to detect significant stenosis or occlusion before adverse event occurs.…”