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: firstname.lastname@example.org
Received May 24, 2012
Accepted December 10, 2012