Wingspan stentの使用経験と文献レビュー

Abstract

We report three cases that involved the use of the Wingspan stent (WS) system for the treatment of intracranial atherosclerotic disease and review the literature. The first patient was an 80-year-old man who presented with recurrence of a transient ischemic attack and medically refractory restenosis of the left petrous internal carotid artery (ICA). He underwent percutaneous transluminal angioplasty (PTA) and stenting using the WS. There have been no ischemic events and no restenosis after treatment. The second patient was a 73-year-old man who presented with minor stroke due to chronic total occlusion of the left ICA. He underwent PTA and stenting using the WS for dissection of the left ICA. There have been no ischemic events and no restenosis after treatment. The third patient was a 65-year-old woman who presented with minor stroke due to stenosis of the right middle cerebral artery (MCA). She underwent PTA and stenting using the WS for dissection of the right MCA. There have been no ischemic events and no restenosis after treatment. The WS system was useful for the treatment of medically refractory restenosis and dissection of intracranial arteries after PTA.The 1-year risk of recurrence of ischemic stroke in the treatment of symptomatic intracranial arterial stenosis (ICAS) with the WS system was lower than that in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. However, the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial demonstrated that aggressive medical treatment was superior to stenting with the WS system in preventing recurrent ischemic stroke. Further evaluation of clinical outcome is required to confirm the safety and efficacy of the WS system for symptomatic ICAS.