Abstract
Four patients underwent angioplasty and stenting of medically refractory symptomatic intracranial atherosclerosis with the new Wingspan stent system. In all 4 patients, CT angiography (CTA) showed an abnormality within the stented segment that was suggestive of nonocclusive in-stent thrombus. However, subsequent conventional angiography findings were typical for in-stent restenosis. The CTA imaging features of in-stent restenosis are important to recognize, and the misinterpretation of in-stent restenosis as in-stent thrombus may result in inappropriate management.
Highlights
We report the CT angiography (CTA) appearance of in-stent restenosis in 4 patients who underwent Wingspan placement
CTA showed a critical stenosis of the right M1 segment of the middle cerebral artery (MCA), which was verified with digital subtraction angiography (DSA) (Fig 1A)
Other Cases Three other patients with restenosis following successful angioplasty and stent placement with the Wingspan system (2 MCAs and 1 supraclinoid internal carotid artery) showed similar findings with irregular nonocclusive filling defects seen on CTA within the Wingspan stent; DSA in all of these patients confirmed the restenosis but showed no evidence of intraluminal thrombus
Summary
SUMMARY: Four patients underwent angioplasty and stenting of medically refractory symptomatic intracranial atherosclerosis with the new Wingspan stent system. Intracranial atherosclerosis accounts for up to 10% of the 700,000 new strokes that occur in the United States each year.[1] Medical therapy has a poor prognosis, and endovascular therapy of this disease has previously been limited due to device technology.[2,3,4] Recently, the Gateway balloon and Wingspan stent (Boston Scientific, Natick, Mass) have been released for treatment of medically refractory significant intracranial stenosis.[5] Little is known about the noninvasive imaging appearance of this device in follow-up after treatment. Extensive case series are beginning to appear in the coronary literature.[7,8] We report the CTA appearance of in-stent restenosis in 4 patients who underwent Wingspan placement
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