Abstract
Background: Percutaneous transluminal angioplasty and stenting with the Wingspan stent has proven safe and effective in patients with middle cerebral artery stenosis (MCAS), but the off-label use of the Neuroform stent might be an alternative treatment. This study aimed to compare the safety and effectiveness of the above two intracranial stents in patients with MCAS.Methods: We retrospectively analyzed consecutive patients with symptomatic MCAS who had been treated with the Neuroform EZ or the Wingspan stent. A propensity score was generated to control for differences in baseline characteristics. The endpoints were the rate of peri-procedural complications within 30 days after stenting, the in-stent restenosis rate, and any target-vessel-related stroke or deaths during follow-up.Results: After matching for propensity score, the peri-procedural complication rate in the Wingspan group was 7.4% compared with 5.6% in the Neuroform group (p = 1.00), while the follow-up in-stent restenosis rates were 23.3 vs. 14.3%, respectively (p = 0.41). In the restenosis group, the patients tended to be younger (p < 0.01) and the degree of artery stenosis before stenting was higher (p < 0.01).Conclusion: This study indicated that in patients with symptomatic MCAS, Neuroform EZ stents are an alternative to Wingspan. Moreover, younger age and higher degree of artery stenosis before stenting might be a risk factor of in-stent restenosis.
Highlights
In the last decade, studies have revealed that intracranial large-artery stenosis or occlusion (ICAS) is more common in patients of Asian, Black, and Hispanic ancestry than in patients who are white [1, 2], and that the incidence of stroke recurrence is much greater with ICAS than without (15–22.1 vs. 5.3–5.5%, p < 0.01) [3, 4]
The exclusion criteria were as follows: a non-atherosclerotic lesion confirmed by high-resolution magnetic resonance imaging (HR-MRI); two or more stents placed after percutaneous transluminal angioplasty; concurrent intracranial pathology including tumors, aneurysms, or arteriovenous malformation; contraindication to heparin, aspirin, clopidogrel, or anesthetic; presence of metal implants contraindicated MRI; women during gestation; and life expectancy of
Higher NIHSS scores on admission (2.88 ± 3.19 vs. 4.69 ± 3.74, p < 0.01), higher degrees of stenosis in the target artery (84.59 ± 8.60 vs. 90.74 ± 10.78, p < 0.01), and more type-C in the Mori classification (34.5 vs. 66.2%, p < 0.01) were found in the Neuroform group
Summary
Studies have revealed that intracranial large-artery stenosis or occlusion (ICAS) is more common in patients of Asian, Black, and Hispanic ancestry than in patients who are white [1, 2], and that the incidence of stroke recurrence is much greater with ICAS than without (15–22.1 vs. 5.3–5.5%, p < 0.01) [3, 4]. Comparing the technical parameters of Wingspan with those of the other intracranial stents, Wingspan exerts the highest radial force, which results in the highest in-stent restenosis (ISR) rate among the stents considered [16]. These studies implied that other intracranial stents besides Wingspan may be safe and effective and even yield a lower rate of ISR. Percutaneous transluminal angioplasty and stenting with the Wingspan stent has proven safe and effective in patients with middle cerebral artery stenosis (MCAS), but the off-label use of the Neuroform stent might be an alternative treatment.
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