Outcome of Patients With ≥70% Symptomatic Intracranial Stenosis After Wingspan Stenting

Abstract

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...

Multicenter Prospective Trial of Stent Placement in Patients with Symptomatic High-Grade Intracranial Stenosis

“…Our results are comparable with the recent data (1-month stroke and/or death rate of 4.4%-6.2%) derived from some high-volume centers (Ͼ100 cases per year). [17][18][19] A retrospective analysis of 96 patients treated with intracranial angioplasty and stent placement at 3 university-affiliated institutions in the United States reported that the overall 1-month stroke and/or death rate was 7.2% in the 69 SAMMPRIS-eligible group and 7.4% in the 27 SAMMPRIS-ineligible group. 20 The 30-day stroke and/or death rate was 3.3% and 10.2% in the SAMMPRIS-eligible, angioplasty-treated subgroup and the stent-treated subgroup, respectively.…”

“…Based on the results of the current study, the China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial has been initiated and is an ongoing, prospective, multicenter randomized trial, which is being conducted in 8 sites intending to recruit 380 subjects (stent placement, 190; medical treatment alone, 190). 28 The study aims to demonstrate a 10.7% absolute reduction in ipsilateral stroke and/or death during 12 months (assuming an event rate of 18% for medically treated patients 3 and 7.3% for stenttreated patients 19 ). The sample size provides 80% power with a 2-sided test at the 5% level of significance and provides a 20% rate of lost follow-up.…”

Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials

“…Although the self-expanding Wingspan stent system was not promising for patients with recent mild stroke (median time from qualifying events of 7 days) when compared with aggressive medical therapy in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, 46 clinical outcomes after the Wingspan were generally favorable in reports from China (including 100 patients; median, 29.5 days) 47 and Korea (77 patients; median, 15 days). 48 In Japan, the Wingspan was approved for commercial use in 2013 after a small domestic trial involving 20 patients with symptomatic intracranial stenosis.…”

Severe symptomatic intracranial internal carotid artery stenosis treated with intracranial stenting: a single center study with 58 patients

“…Intracranial angioplasty and stenting has become an important approach in combination with intensive medications to treat intracranial stenosis (3,5). Compared with extracranial ICA stenting (9,10), stenting in the intracranial ICA segments is relatively immature with more perioperative complications, higher long-term in-stent restenosis rates, and higher recurrent rates of ischemic stroke (11,12).…”