Intracranial Stenting With Wingspan

Abstract

See related articles, pages 1971–1975 and 1976–1981. Intracranial atherosclerotic disease (ICAD) is a major cause of stroke and yet there are no proven effective treatments for it. Medical therapy has been associated with a high rate of recurrence, particularly in those with the most severe stenoses who have a 22.5% risk of stroke or death in the first year after a stroke.1 Clearly better alternatives are needed. Surgical bypass has been shown in at least 1 trial to be worse than medical therapy in the era before thienopyridines, statins, and angiotensin-converting enzyme inhibitors. In this issue of Stroke , Fiorella and colleagues describe their longer-term experience with intracranial stenting with the Wingspan (Stryker Inc, Fremont, CA) stent system and last year in this Journal, Jiang and colleagues published their long-term experience with 100 consecutive patients also treated with the Wingspan stent system.2,3 The question is do these publications broaden our knowledge enough to alter management of patients with ICAD? Do they prove that endovascular therapy is superior to medical treatment and that it is safe enough to be performed routinely? The article by Fiorella et al represents the largest (N=158) published series of Wingspan in the United States to treat ≥50% symptomatic stenoses.2 The immediate perioperative stroke and death rates were 5.7% (N=9) and 2.5% (N=4), respectively. Over a mean follow-up period of 14.2 months (only 110 patients [69.6%] had 12 months of follow-up), the primary end point (any perioperative stroke or death and any ipsilateral stroke thereafter) was noted in 15.7% of patients or approximately 13.2%/year. Seventy-six percent of the ipsilateral strokes occurred within the first 6 months with no events beyond 12 months. These event rates did not include transient ischemic attacks (TIAs) and did not include target lesion revascularization (TLR) for …