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Wingspan Stenting for Intracranial Atherosclerotic Stenosis: Clinical Outcomes and Risk Factors for In-Stent Restenosis

Shin, Yong Sam MD*; Kim, Byung Moon MD; Suh, Sang Hyun MD§; Jeon, Pyoung MD; Kim, Dong Joon MD; Kim, Dong Ik MD; Kim, Bum-soo MD; Kim, Keon Ha MD; Heo, Ji Hoe MD#; Nam, Hyo Suk MD#; Kim, Young Dae MD#

doi: 10.1227/NEU.0b013e3182846e09
Research-Human-Clinical Studies

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.

ABBREVIATIONS: CI, confidence interval

ICA, internal carotid artery

ICAS, intracranial atherosclerotic stenosis

ISR, in-stent restenosis

PTAS, percutaneous transluminal angioplasty and stenting

SAMMPRIS, Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial

TIA, transient ischemic attack

WASID, Warfarin-Aspirin Symptomatic Intracranial Disease

Departments of *Neurosurgery and

Radiology, The Catholic University College of Medicine, Seoul St. Mary's Hospital, Seoul, South Korea

Departments of Radiology and

#Neurology, Severance Hospital and

§Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

Correspondence: Byung Moon Kim, MD, PhD, Division of Interventional Neuroradiology, Department of Radiology, Severance Hospital Yonsei University College of Medicine, 50 Yonsei-ro, 120-752, Seodaemun-gu, Seoul, South Korea. E-mail: bmoon21@hanmail.net

Received May 24, 2012

Accepted December 10, 2012

Copyright © by the Congress of Neurological Surgeons