Long-term Outcome of Angioplasty Using aWingspan Stent, Post-Stent Balloon Dilation and Aggressive Restenosis Management for Intracranial Arterial Stenosis.

Abstract

To investigate the long-term outcome of stent angioplasty for symptomatic severe intracranial artery stenosis. In this study 95 consecutive patients with intracranial atherosclerotic stenosis (>70%) underwent stent angioplasty using Wingspan stents. The primary endpoints were stroke or death within 30days of the procedure and subsequent stroke attributed to the stented vessel. Disabling stroke was defined as stroke with amodified Rankin scale > 3.Secondary endpoints included transient ischemic attacks, contralateral stroke, nonstroke death, and other events. Patients underwent prestent balloon dilation with or without poststent balloon dilation, close restenosis follow-up, and selective retreatment, as required. The mean follow-up duration was 34.9 ± 23.3months. Primary endpoint events occurred in 23% of the patients. The median infarction volume was 2.6ml, and 11 (68%) of 16 infarctions were <5ml in volume. Disabling stroke occurred in 3% of patients. The primary endpoint rates were 17.9% within 30days and 2.1% from 30days to 1year. Secondary endpoint events occurred in 27.3% of the patients. Mean stenosis was reduced from 76.8 ± 6.1% to 7.5 ± 13.4%. Of 80patients who underwent angiographic follow-up, 11 (14%) experienced restenosis (≥50%) and 7 (9%) exhibited restenosis-related symptoms of transient ischemic attack. The rate of symptomatic restenosis was significantly higher in patients who underwent prestent balloon dilation alone than in patients who underwent prestent and poststent balloon dilation (p = 0.016). The postprocedural stroke rate was similar to that observed in the SAMMPRIS study. Symptomatic restenosis may be reduced by poststent dilation, close angiographic follow-up, and retreatment.