Objective-To assess the safety and clinical efficacy of stenting for patients with symptomatic M1 stenosis of middle cerebral artery (MCA), and to assess the significance of classification based on location, morphology, and access of intracranial stenosis (LMA classification) in MCA stenting. Methods-Forty patients with 42 symptomatic M1 stenoses refractory to medical therapy were enrolled in this study. The lesions were situated at M1 trunk (nϭ13), M1 origin (nϭ12), and M1 bifurcation (nϭ17), respectively, which were classified into type N (nonbifurcation lesions, nϭ13) and type A (prebifurcation, nϭ11), B (postbifurcation, nϭ14), C (lesion across the nonstenotic ostium of its branch, nϭ1), D (across the stenotic ostium of its branch, nϭ2), F (combinative lesions of prebifurcation and its small branch ostium, nϭ1) locations, morphologically into type A (nϭ15), B (nϭ23) and C (nϭ4) lesions, and into type I (mild-to-moderate tortuosity and smooth access, nϭ17), II (severe tortuosity and/or irregular arterial wall, nϭ18), and III (excessively severe tortuosity, nϭ7) accesses. Results-The technical successful rate was 97.6% for total lesions and 100%, 100%, and 85.7% for types I, II, and III accesses, respectively. The total complication rate was 10%. The mortality was 2.5% (1/40 patients), and 0%, 0%, and 25% for types A, B, and C lesions, respectively. During the median 10 months follow-up, there was no recurrence of transient ischemic attack or stroke in 38 available patients. Among 8 stenting vessels of seven patients with six-month follow-up angiography, 7 showed good patency and one showed restenosis. Conclusion-Stenting appears to be an effective and feasible therapy for symptomatic M1 stenoses, but also appears to have the higher periprocedural complications, which need strict procedural and periprocedural management to reduce the mortality and morbidity. The LMA classification seems to be helpful to work out the individual therapy and predict the results of stenting. A further study is needed to confirm the benefits of stenting of MCA stenosis.

3-T high-resolution PDW imaging is a reproducible tool for measuring BA dimensions. In patients with advanced BA atherosclerosis, PR lesions are more frequently observed and contain larger plaques than non-PR lesions.

Background and Purpose-There were limited data on the long-term outcome of patients with symptomatic intracranial atherosclerotic stenosis Ն70% after Wingspan stenting. Using our Wingspan cohort data and the data from the Warfarin and Aspirin for Symptomatic Intracranial Atherosclerotic Disease (WASID) as a historical control, we tested the hypothesis that stenting provided no benefit over antithrombotic therapy alone for these high-risk patients. Methods-Between January 2007 and February 2009, 100 consecutive patients with intracranial atherosclerotic stenosis Ն70% and symptoms within 90 days were enrolled into this prospective single-center Wingspan cohort study and followed up until the end of February 2010. Stenosis was measured per the WASID criteria. One-year risk of primary end point (any stroke or death within 30 days and ipsilateral ischemic stroke afterward) was compared with that of ipsilateral ischemic stroke in the WASID patients with Ն70% stenosis. Results-The stent placement success rate was 99%. All patients but 1 had clinical follow-up of Ն12 months. During a mean follow-up of 1.8 years, 9 patients developed primary end point events (5 within 30 days and 4 afterward). The 1-year risk of the outcome events was lower than that in similar WASID patients: 7.3% (95% CI, 2.0% to 12.5%) versus 18% (95% CI, 13% to 24%; PϽ0.05). Conclusions-The clinical outcome of Wingspan stenting for high-risk intracranial atherosclerotic stenosis patients in thishigh-volume center study compares favorably with that of antithrombotic therapy alone. A randomized trial comparing medical therapy alone with medical therapy plus Wingspan stenting, conducted at high-volume centers, is needed to confirm the stenting benefit. Key Words: angioplasty and stenting Ⅲ atherosclerosis Ⅲ intracranial stenosis Ⅲ outcome T he Warfarin and Aspirin for Symptomatic Intracranial Atherosclerotic Disease (WASID) trial showed that patients with symptomatic intracranial arterial stenosis (ICAS) Ն70% are at particularly high risk of recurrent stroke at the time of being on medical therapy. 1,2 There has been increased enthusiasm for the use of Wingspan stents (Boston Scientific) to treat these high-risk patients in recent years. [3][4][5] However, there were limited data on long-term outcome after this aggressive therapy. In a multicenter registry, Wingspan stenting seemed to have no advantage compared with medical therapy. 3 However, the study showed a significantly lower stroke rate in high-volume centers versus low-volume centers.The Stenting and Aggressive Medical Management for the Prevention of Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial is currently in progress comparing aggressive medical management alone with medical management plus Wingspan stenting in patients who have a 70% to 99% ICAS and a qualifying event within 30 days. 6 The trial is anticipated to be completed by 2013. Until then, physicians and patients are in a quandary when making a decision on Wingspan stenting.Using our Wingspan cohort data and the WASID da...