Abstract
Background: Wingspan stent has gained interest for better long-term outcomes for intracranial atherosclerosis disease (ICAD). However, in-stent restenosis still presents as a problem and may cause postoperative neurological events. We aimed to find a way to prevent in-stent restenosis.Method: Patients with stenosis >70% ICAD were treated with wingspan stent and were retrospectively reviewed. The patients were separated into two groups: one with post-dilation and the other without post-dilation. The outcomes of wingspan stenting were compared immediately after the surgery and at a 1-year follow-up.Results: Overall, 28 patients were included for analysis, with 15 patients undergoing post-dilation and 13 patients not undergoing the procedure. The extent of stenosis was significantly lower in the post-dilation group than in the no post-dilation group, both immediately after the surgery (14.8 ± 10.2 vs. 28.5 ± 14.5%, p < 0.01) and at 1-year follow-up (25.8 ± 18.0 vs. 50.1 ± 23.2%, p < 0.01). The post-dilation method immediately expanded the stent diameter (2.89 ± 0.48 vs. 3.05 ± 0.44 mm, p < 0.001), and the diameter still increased at 1-year follow-up (3.05 ± 0.44 vs. 3.12 ± 0.43 mm, p < 0.01) due to the self-expandable property of the wingspan. Similarly, in the no post-dilation group, the stent size was also increased (2.70 ± 0.67 vs. 2.80 ± 0.64 mm, p < 0.01). However, at 1-year follow up, the luminal diameter was stationary in the post-dilation group (2.36 ± 0.73 vs. 2.46 ± 0.82 mm, p = 0.88) and decreased in the no post-dilation group (2.24 ± 0.56 vs. 1.60 ± 0.79 mm, p < 0.01). The periprocedural complication rate was similar between the groups.Conclusion: The post-dilation method can be feasibly performed and can offer better stent expansion and apposition in the wingspan system. By applying this technique, we might prevent in-stent restenosis and improve neurological outcomes.
Highlights
Intracranial atherosclerosis disease (ICAD) accounts for nearly 10% of the stroke and transient ischemic attack (TIA) cases worldwide [1] and up to 50% of the cerebral vascular events in the Chinese population [2]
The inclusion criteria for wingspan stenting included [1] ICAD with the extent of stenosis >70% using the WASID measurement method [15], [2] the stenosis lesion corresponded to the neurologic events, and [3] the interval from the final stroke or TIA to the surgery was at least 3 weeks [16]
Using a post-dilation method, we significantly reduced the incomplete apposition and expanded the wingspan system, which might help avoid in-stent restenosis at a 1-year follow-up
Summary
Intracranial atherosclerosis disease (ICAD) accounts for nearly 10% of the stroke and transient ischemic attack (TIA) cases worldwide [1] and up to 50% of the cerebral vascular events in the Chinese population [2]. Several clinical trials have evaluated the effect of medical treatment in comparison to percutaneous transluminal angioplasty and stenting (PTAS) on the prevention of stroke, including SAMPPRIS and VISSIT. The results showed a higher 30-day stroke or death rate in the PTAS group (14.7–24.1%) than in the medical group (5.8–9.4%) [4, 5]. The aggressive medical treatment seemed to reduce 1-year stroke or death rate (12.2– 15.1%) when compared with the WASID trial (21.8–22.1%) [6]. With improvements in surgery technique, PTAS had resurfaced after the WEAVE trial, with its conclusion stating that with careful patient selection criteria and adequate surgeon experience, the periprocedural stroke and death rate were lower than expected (2.6%) [7]. Wingspan stent has gained interest for better long-term outcomes for intracranial atherosclerosis disease (ICAD). We aimed to find a way to prevent in-stent restenosis
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