Long term clinical and angiographic outcomes with the Wingspan stent for treatment of symptomatic 50–99% intracranial atherosclerosis: single center experience in 51 cases

Wolfe, Thomas; Fitzsimmons, Brian‐Fred; Hussain, Syed; Lynch, John; Zaidat, Osama O.

doi:10.1136/jnis.2009.000331

Cited by 17 publications

(16 citation statements)

References 29 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The technical success rate for stent implantation was 97% in our study, which was in accordance with previously reported success rates [an unsuccessful stent implantation occurred in our patient who had residual stenosis (60%) in the MCA]. The ischemic stroke and mortality rates after the procedure have ranged from 3.2 to 10% [26,27,28]. Suh et al [29] reported on cases with intracranial stenosis that were ≥70% and were treated with various types of BMS.…”

Section: Discussionsupporting

confidence: 91%

A Comparison of Stent Implant versus Medical Treatment for Severe Symptomatic Intracranial Stenosis: A Controlled Clinical Trial

Mohammadian

Pashapour

Sharifipour

et al. 2012

Cerebrovasc Dis Extra

View full text Add to dashboard Cite

Background: Atherosclerotic stenosis of the major intracranial arteries is the most common cause of ischemic stroke. There are limited treatments for severe intracranial stenosis, and stent placement versus medical treatment remains controversial. The aim of this study was to compare functional outcomes of these two modalities in patients with severe symptomatic intracranial stenosis. Methods: At a single center, between 2008 and 2011, patients with angiographically demonstrated severe (70–90%) symptomatic intracranial atherosclerosis were divided into two groups: group A, which received only medical treatment, and group B, which underwent endovascular stent implant treatment. The severity and location of the stenosis was determined by digital subtraction angiography and the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial criteria in all patients. The exclusion criteria were: specific causes other than atherosclerosis, such as artery dissection, fibromuscular dysplasia, vasculitis, radiation and intracranial hemorrhage, focal neurological deficit that did not correlate to internal carotid artery or middle cerebral artery stenosis. All procedures were done under light anesthesia. Technical success was defined as the reduction of stenosis to <30% with complete enveloping of the lesion after the procedure. Early and late adverse events and functional outcomes were compared between the groups using the modified Rankin Scale (mRS). Results: Overall, 63 patients (29 in group A and 34 in group B) were evaluated and followed for a mean period of 15.22 months (range 6–25). The technical success rate was 97% in a total of 34 stents in 34 patients. There was no difference between the early (within 30 days) adverse event rates of the two groups. The median follow-up duration for the stent implant patients was 15 months (range 6–25), and for the medically treated cohort it was 14 months (range 8–25). The re-stenosis rate was 5.8% and the total number of late (>30 days) adverse events, including stroke, myocardial infarction and death, was 1 (2.9%) and 6 (20.7%) in the stent implant and medical groups, respectively (p = 0.042). The stent implant group had significantly better favorable functional outcomes according to the mRS than the medical group (93.9 vs. 63.0%). The cumulative secondary adverse event-free survival was significantly lower in the stent implant group. Conclusion: Stent implants can be considered more durable and safe for patients with symptomatic severe stenosis of the internal carotid artery or middle cerebral artery, despite optimal medical therapy. Randomized, multicenter trials are required to confirm these results.

show abstract

Section: Discussionsupporting

confidence: 91%

A Comparison of Stent Implant versus Medical Treatment for Severe Symptomatic Intracranial Stenosis: A Controlled Clinical Trial

Mohammadian

Pashapour

Sharifipour

et al. 2012

Cerebrovasc Dis Extra

View full text Add to dashboard Cite

show abstract

“…In that study, the mean imaging follow-up time was 8.5 months rather than 12 months (range 3–15.5) 8. In a single-center study in the USA the ISR rate was 24% (7/29) on DSA at a mean of 8.6 months (range 3–20) 10. In another paper based on the same American multicenter study, the ISR was noted to be associated with younger age (45.2% (14/31) at ≤55 years of age vs 23.2% (15/62) at >55 years) and with location of the lesion in the internal carotid artery (43.7% (14/32) vs 24.6% (15/61) at other locations) 9.…”

Section: Discussionmentioning

confidence: 88%

Angioplasty and stenting of intracranial atherosclerosis with the Wingspan system: 1-year clinical and radiological outcome in a single Asian center

Leung

Lee

et al. 2013

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundThis study aimed to evaluate the 1-year clinical and angiographic outcome of angioplasty and stenting of intracranial atherosclerosis using Wingspan and Gateway system.MethodsIn this prospective study, patients with symptomatic lesions were treated and followed clinically and angiographically by digital subtraction angiography (DSA) for 1 year. The two primary endpoints were recurrent ipsilateral ischemic stroke and in-stent restenosis (ISR) at 1 year. Secondary endpoints included periprocedural death or stroke and all strokes at 1 year. Potential factors correlated with ISR were studied using univariate and multivariate analysis.ResultsTreatment was attempted in 65 patients and successfully completed in 61 (93.8%). Fifty-nine patients (44 men, 15 women) aged 62.86±11.38 years with 66 stenoses (average degree of stenosis 71.78±11.23%) underwent clinical and DSA follow-up at 1 year. There were 66 stenotic lesions. ISR occurred in 11 of the 66 lesions (16.7%). Luminal gain occurred in 32 of the lesions (48.5%), an unchanged lumen in 4 (6%) and luminal loss in 30 (45.4%). The periprocedural stroke or death rate was 6.1% (4/65), including three hemorrhagic and one ischemic stroke, all of which occurred at the corresponding site and resulted in death. There were no interval strokes between the periprocedural time and the 1-year follow-up. The occurrence of ISR was correlated with the degree of stenosis before treatment and was not correlated with patient age or sex, vessel diameter, location of stenosis or failure to control risk factors for atherosclerosis.ConclusionsOne-year clinical and angiographic outcomes of angioplasty and stenting are promising for symptomatic intracranial atherosclerosis.

show abstract

“…According to previous reports, ISR was observed in 24%-35% of the patients, 9,10,19,20) but the mean follow-up period was 8 months in many of these reports and 2-3 months in some. 19,20) In our study, on serial evaluations until 1 year after the procedure, the percent stenosis increased at 3-6 months compared with the state immediately after the procedure in seven lesions (7/11, 64%) but decreased at 1 year (3M vs. 1Y: p = 0.080, 6M vs. 1Y: p = 0.085), and the luminal diameter was increased at 1 year compared with the state immediately after the procedure in six lesions (6/12, 50%).…”

Section: Discussionmentioning

confidence: 99%

“…19,20) In our study, on serial evaluations until 1 year after the procedure, the percent stenosis increased at 3-6 months compared with the state immediately after the procedure in seven lesions (7/11, 64%) but decreased at 1 year (3M vs. 1Y: p = 0.080, 6M vs. 1Y: p = 0.085), and the luminal diameter was increased at 1 year compared with the state immediately after the procedure in six lesions (6/12, 50%). As a result, ISR was observed in two lesions at 3-6 months but only one lesion (8.3%) at 1 year.…”

Section: Discussionmentioning

confidence: 99%

Angioplasty and Stenting for Intracranial Atherosclerosis with the Wingspan System: Long-term Clinical and Radiological Outcome

Suda¹,

Iwaya²,

Kikuchi³

et al. 2017

JNET

View full text Add to dashboard Cite

Objective:We examined the long-term incidence of in-stent restenosis (ISR) on angiographic follow-up and ipsilateral ischemic events after Wingspan stenting for intracranial arterial stenosis.Methods: Between July 2014 and September 2015, patients who underwent Wingspan treatment at our institution and have been followed for more than 1 year were retrospectively analyzed. Results:In all, 13 lesions of 12 patients (average age, 67.1 years; 9 men) were enrolled. Target lesions involved nine internal carotid, three middle cerebral, and one vertebral artery. Wingspan was successfully placed in all 13 lesions.Pretreatment stenosis was 79.7 ± 9.3% (mean ± SD), which improved to 20.8 ± 9.6% after stent placement (p <0.001).There was one temporary periprocedural neurological complication and no ischemic stroke in follow-up (mean follow-up: 20.4 months). At 3-6 months, aggravation of the stenosis occurred in seven patients; however, all lesions improved 1 year later. As a result, ISR was demonstrated in one patient (8.3%). Conclusion:One-year clinical and angiographic outcomes of Wingspan stenting were promising for intracranial atherosclerotic diseases.Keywords▶ intracranial atherosclerotic disease, percutaneous transluminal angioplasty/angioplasty, Wingspan stent, in-stent restenosis

show abstract

Long term clinical and angiographic outcomes with the Wingspan stent for treatment of symptomatic 50–99% intracranial atherosclerosis: single center experience in 51 cases

Abstract: The use of the Wingspan stent in patients with ≥50% symptomatic intracranial stenosis is associated with good long term clinical outcome. One stroke occurred after the first 30 days, suggesting a significant stabilization of the adverse event rate after the first month.

Cited by 17 publications

References 29 publications

A Comparison of Stent Implant versus Medical Treatment for Severe Symptomatic Intracranial Stenosis: A Controlled Clinical Trial

A Comparison of Stent Implant versus Medical Treatment for Severe Symptomatic Intracranial Stenosis: A Controlled Clinical Trial

Angioplasty and stenting of intracranial atherosclerosis with the Wingspan system: 1-year clinical and radiological outcome in a single Asian center

Angioplasty and Stenting for Intracranial Atherosclerosis with the Wingspan System: Long-term Clinical and Radiological Outcome

Contact Info

Product

Resources

About