J Cerebrovasc Endovasc Neurosurg.  2012 Sep;14(3):157-163. 10.7461/jcen.2012.14.3.157.

Clinical and Angiographic Outcomes of Wingspan Stent Placement for Treatment of Symptomatic Intracranial Stenosis: Single Center Experience with 19 Cases

• Lee JH
• Yun JK
• Kim DW
• Kang SD

• KMID: 1808449
• DOI: http://doi.org/10.7461/jcen.2012.14.3.157

Abstract

OBJECTIVE
The limitations of medical management of symptomatic intracranial arterial stenosis (ICS) have prompted development of new strategies, including endovascular treatment. However, stenting of symptomatic ICS remains investigational. Here, we have reported and analyzed a series of 19 endovascular procedures involving placement of a Wingspan stent.
METHODS
We conducted a retrospective review of a series of ICS in which patients were treated with percutaneous transarterial balloon angioplasty and stent placement (PTAS). Patients included in the study were diagnosed as symptomatic ICS between May 2010 and September 2011.
RESULTS
Nineteen patients (median age, 65 years; 12 males, seven women) were treated with the Wingspan stent system for symptomatic ICS ranging from 50% to 99%. The technical success rate was 100%. The location of ICS included the internal carotid (n = 5; 1 petrous, 3 cavernous, and 1 clinoid segments), vertebral (n = 1; V4 segment), basilar (n = 1), and middle cerebral (n = 12; 9 M1, 3 M2) arteries. There was no occurrence of procedure-related mortality. Periprocedural morbidity occurred in two cases (10.5%), including carotid-cavernous fistula (n = 1) and subarachnoid hemorrhage (n = 1). No ipsilateral stroke was recorded beyond 30 days during a mean follow-up period of 13.2 months (range 9-19 months). Restenosis (> 50%) was observed in one patient (6.3%), who was asymptomatic, on follow-up imaging.
CONCLUSION
Wingspan stent for symptomatic ICS can be performed with a high rate of technical success and acceptable periprocedural morbidity rates. Our initial experience indicates that this procedure represents a viable treatment option for this patient population.

Keyword

Intracranial stenosis; Angioplasty; Stent implantation; Wingspan stent

MeSH Terms

Angioplasty
Angioplasty, Balloon
Arteries
Caves
Constriction, Pathologic
Endovascular Procedures
Fistula
Follow-Up Studies
Humans
Male
Retrospective Studies
Stents
Stroke
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 (A) Cerebral angiography shows M1 (black arrow) and M2 (open arrow) stenosis (60% and 90%). (B) Cerebral angiography after percutaneous transarterial balloon angioplasty and stent placement (PTAS) with a Wingspan stent for M1 stenosis and percutaneous transarterial balloon angioplasty (PTA) for M2 stenosis shows successful reduction of the stenosis. (C) Follow up computed tomography (CT) image shows subarachnoid hemorrhage (SAH) in the right fontal and temporal area.

• 

  Fig. 2 Antero-posterior (A) and lateral (B) cerebral angiography shows 75% stenosis of the right cavernous internal carotid artery (ICA). (C) PTAS was performed successfully. Some degree of residual stenosis is shown (~25%). (D) Cerebral angiography shows a carotid-cavernous fistula (CCF) after PTAS. (E) After coil embolization, cerebral angiography shows near total occlusion of the CCF.

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