Endovascular treatment of symptomatic intracranial stenosis with the Wingspan stent system and Gateway PTA balloon: a multicenter series of 60 patients with acute and midterm results

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  • 1 Department of Neuroradiology, Montpellier University Hospital, Montpellier;
  • 2 Department of Neuroradiology, Sainte-Anne Army Hospital, Toulon;
  • 3 Department of Diagnostic and Interventional Neuroradiology, Lyon Neurological Hospital, Lyon;
  • 4 Department of Neuroradiology, Nantes University Hospital, Nantes; and
  • 5 Department of Neuroradiology, Nice University Hospital, Nice, France
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Object

The limitations of the medical management of symptomatic intracranial arterial stenosis (SIAS) have encouraged the development of new strategies, such as endovascular treatment. In this study, the authors report and analyze a series of 63 endovascular procedures in which the Wingspan stent system was used.

Methods

Data from 60 patients presenting with refractory SIAS, treated in 5 French neurointerventional centers between September 2006 and August 2009, were retrieved. An angiogram was systematically obtained 6 months after the procedure and yearly thereafter. The clinical neurological status was assessed and reported using the modified Rankin scale at 1-month, 6-month, and 1-year follow-up visits.

Results

A total of 63 stenotic lesions was treated. The mean age of the patients was 65.3 years, and the mean diameter of the stenosis was 80.2%. Technical success was achieved in 95.2% of cases. The overall incidence of procedural complications was 20.6%, with a 4.8% rate of permanent postoperative morbidity and death. In-stent restenosis (ISR)/occlusion occurred in 11 cases (17.4%), of which 10 were asymptomatic and 9 were detected less than 1 year from the endovascular treatment. In 1 case, the patient presented with a recurrent transient ischemic attack and was treated again with angioplasty. The mean follow-up was 13.2 months.

Conclusions

Endovascular treatment of SIAS demonstrates a moderate risk of neurological complication. Nevertheless, considering the critical natural history of severe refractory lesions, this may be considered the first alternative in cases of failed medical therapy. Technical failure, residual stenosis, or in-stent restenosis did not lead to systematic recurrent stroke in this series, which suggests the importance of plaque stabilization and neoendothelialization.

Abbreviations used in this paper: BA = basilar artery; DS = digital subtraction; ICA = internal carotid artery; ISR = in-stent restenosis; MCA = middle cerebral artery; mRS = modified Rankin Scale; NIHSS = National Institutes of Health Stroke Scale; PCA = posterior cerebral artery; PTA = percutaneous transluminal angioplasty; SAH = subarachnoid hemorrhage; SIAS = symptomatic intracranial arterial stenosis; TIA = transient ischemic attack; VA = vertebral artery; WASID = Warfarin-Aspirin Symptomatic Intracranial Disease.

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Contributor Notes

* Drs. Costalat and Maldonado contributed equally to this work.

Address correspondence to: Igor Lima Maldonado, M.D., Service de Neuroradiologie, Centre Hospitalier Universitaire de Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. email: imaldonado@terra.com.br.

Please include this information when citing this paper: published online July 8, 2011; DOI: 10.3171/2011.5.JNS101583.

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