Stenting for the treatment of high-grade intracranial stenoses

Abstract

To date, evidence to recommend endovascular treatment in patients with intracranial stenoses is lacking. Recently, the introduction of self-expanding stents (Wingspan Stent System) aroused considerable expectations in their employ for stroke prevention. We report a single-center experience of percutaneous transluminal angioplasty and stenting in a series of consecutive patients with intracranial stenoses and compare the safety and performance of balloon-mounted stents versus self-expanding stent systems (Wingspan). Thirty-four patients with 39 severe (>70%) intracranial stenoses were treated during a 6-year period. An independent stroke neurologist collected data about intra and periprocedural complications and short-term outcome. We considered as endpoint measures (1) any 30-day stroke or death (2) any major 30-day complication and (3) procedure technical success. Technical success was achieved in all patients. No vessel dissection or ruptures were observed. The 30-day stroke/death rate was 17.9%. Five ischemic strokes in the territory of treated vessels and two intracranial hemorrhages occurred respectively within 24 h and 5 days after endovascular treatment. Three (17.6%) patients of Wingspan treated group and four (18.2%) of the patients treated with different stent systems had unfavorable outcome. Our study confirms that endovascular treatment can be performed with a high technical success rate, even though the safety of these devices has still to be demonstrated.

Wingspan Stents for the Treatment of Symptomatic Atherosclerotic Stenosis in Small Intracranial Vessels: Safety and Efficacy Evaluation

“…Several research studies reported that the incidence of complications was 15%-30% when using a coronary balloon stent for intracranial stenosis, whereas the incidence was about 5%-18% when using a Gateway balloon and Wingspan stent. [10][11][12][13][14][15][16][17][18][19] After Wingspan stent placement, the residual stenoses were 0%-50% (with a mean of 13.0 Ϯ 3.4%). The average residual stenoses of patients who had a follow-up was 10.7%.…”

Staged Surgical Treatment for Symptomatic Vertebrobasilar Artery Stenosis: Combined Treatment with Endovascular Angioplasty and Bypass Surgery

“…Subgroups of patients who are most likely to benefit from interventional procedures are unclear. Endovascular treatment should not be the first-line treatment in patients with severe symptomatic intracranial stenosis (10). Bypass surgery for VBA stenosis prevents ischemic attacks in the long term.…”

Progress in cerebrovascular disease research in the last year

“…Recently, the SAMM-PRIS trial showed that aggressive medical management was superior to percutaneous transluminal angioplasty and stenting (PTAS) with the use of the Wingspan stent system. Lanfranconi et al [8] reported their single-center experience of PTAS in consecutive patients with intracranial stenosis and compared the safety and performance of balloon-mounted stents versus self-expanding stent systems (Wingspan). A total of 34 patients with 39 severe ([70%) intracranial stenosis were analyzed.…”