A single-center study of Wingspan stents for symptomatic atherosclerotic stenosis of the middle cerebral artery

Abstract

The middle cerebral artery (MCA) is one of the most common sites of symptomatic intracranial atherosclerosis. We assessed the safety and efficacy of the Wingspan stent (Boston Scientific, Natick, MA, USA) for the treatment of symptomatic atherosclerotic MCA stenosis. Sixty-one patients with symptomatic MCA stenosis with narrowing of at least 70% among 61 patients were treated using Wingspan stents from March 2007 to December 2010. Clinical outcomes and imaging features were recorded and analyzed. The technical success rate was 98.4%. The rate of procedure-related complications during the periprocedural period (30days) was 5.0% (three of 61 patients), which included one ischemic complication and two hemorrhagic complications with no permanent neurological sequelae. The mean degree of stenosis decreased from 76.8±6.0% to 12.0±11.5% following treatment. Forty-five patients (74%) were available for follow-up imaging with digital subtraction arteriography. In-stent restenosis (ISR) was documented in seven of these patients. A total of 61 patients were available for a clinical follow up. Four ischemic events (6.6%) occurred during the follow-up period, which were all transient ischemic attacks including two symptomatic ISR. The cumulative probability of an adverse event was 11.7% at 1year. Of the 61 patients, 51 (83.6%) had their follow-up visit more than 12months after the procedure, and no adverse events were found beyond 12months after the procedure. Percutaneous transluminal angioplasty and stenting of the MCA was safe and associated with a low periprocedural complication rate. It may result in a good long-term benefit. Prospective randomized controlled trials and further long-term follow up are needed to provide more adequate statistical evidence to support our findings.