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01-02-2016 | Interventional Neuroradiology

Outcomes of middle cerebral artery angioplasty and stenting with Wingspan at a high-volume center

Authors: Zi-Liang Wang, Bu-Lang Gao, Tian-Xiao Li, Dong-Yang Cai, Liang-Fu Zhu, Jiang-Yu Xue, Wei-Xing Bai, Zhao-Shuo Li

Published in: Neuroradiology | Issue 2/2016

Abstract

Introduction

This study was to investigate the periprocedural stroke rates, safety, and long-term effect of Wingspan stenting for symptomatic severe stenosis of the middle cerebral artery (MCA) at a high-volume center.

Methods

Between July 2007 and April 2013, 196 consecutive patients with severe MCA atherosclerotic stenosis (≥70 %) who were treated with Wingspan stenting were retrospectively studied. All patients had arterial stenosis-related temporary ischemic attack or strokes. The demographic data, cerebral angiography, technical success rate, periprocedural complications, and clinical and imaging follow-up were analyzed.

Results

The successful stenting rate was 98.0 %, and the stenosis rate was improved from pre-stenting (80.6 ± 8.3 %) to post-stenting (15.5 ± 6.8 %). The 30-day periprocedural stroke or death rate was 7.1 %, with a disabling or fatal rate of 2.6 %. The perioprocedural stroke rate was significantly (P < 0.01) greater in the early learning stage (16.0 %) than in the later technical maturation stage (4.1 %). The total periprocedural ischemic and perforator stroke rates were greater in patients with the most stenosis in the distal MCA 1/3 segment (6.8 and 5.7 %, respectively) than in the proximal and middle 2/3 segments (0.9 and 0 %, respectively). The ipsilateral stroke or death rate beyond 30 days (6–69 months, mean 30 ± 16) was 4.8 %, with the 1- and 2-year cumulative stroke rates of 9.6 and 12.1 %, respectively. Imaging follow-up 6–69 months (mean 10.9 ± 8.5) revealed restenosis in 21 cases (20.4 %).

Conclusion

Intracranial stenting of MCA stenoses may have the potential of better clinical outcomes if patients are properly selected and treated by an experienced operator at a high-volume center.

Al Hasan M, Murugan R (2012) Stenting versus aggressive medical therapy for intracranial arterial stenosis: more harm than good. Crit Care 16:310CrossRefPubMedPubMedCentral

Sacco RL, Kargman DE, Gu Q, Zamanillo MC (1995) Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 26:14–20CrossRefPubMed

Zaidat OO, Klucznik R, Alexander MJ et al (2008) The NIH registry on use of the Wingspan stent for symptomatic 70-99% intracranial arterial stenosis. Neurology 70:1518–1524CrossRefPubMedPubMedCentral

Wong KS, Huang YN, Gao S, Lam WW, Chan YL, Kay R (1998) Intracranial stenosis in Chinese patients with acute stroke. Neurology 50:812–813CrossRefPubMed

Chimowitz MI, Lynn MJ, Howlett-Smith H et al (2005) Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352:1305–1316CrossRefPubMed

Chimowitz MI, Lynn MJ, Derdeyn CP et al (2011) Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365:993–1003CrossRefPubMedPubMedCentral

Jiang WJ, Xu XT, Du B et al (2007) Comparison of elective stenting of severe vs moderate intracranial atherosclerotic stenosis. Neurology 68:420–426CrossRefPubMed

Jiang WJ, Yu W, Du B, Gao F, Cui LY (2011) Outcome of patients with >/=70% symptomatic intracranial stenosis after Wingspan stenting. Stroke 42:1971–1975CrossRefPubMed

Park S, Kim JH, Kwak JK et al (2013) Intracranial stenting for severe symptomatic stenosis: self-expandable versus balloon-expandable stents. Interv Neuroradiol 19:276–282PubMedPubMedCentral

10.

Turk AS, Levy EI, Albuquerque FC et al (2008) Influence of patient age and stenosis location on wingspan in-stent restenosis. AJNR Am J Neuroradiol 29:23–27CrossRefPubMed

11.

Yu SC, Leung TW, Lee KT, Hui JW, Wong LK (2011) Angioplasty and stenting of atherosclerotic middle cerebral arteries with Wingspan: evaluation of clinical outcome, restenosis, and procedure outcome. AJNR Am J Neuroradiol 32:753–758CrossRefPubMed

12.

Yu SC, Leung TW, Lee KT, Wong LK (2014) Angioplasty and stenting of intracranial atherosclerosis with the Wingspan system: 1-year clinical and radiological outcome in a single Asian center. J Neurointerv Surg 6:96–102CrossRefPubMedPubMedCentral

13.

Derdeyn CP, Chimowitz MI, Lynn MJ et al (2014) Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet 383:333–341CrossRefPubMedPubMedCentral

14.

Guo XB, Ma N, Hu XB, Guan S, Fan YM (2011) Wingspan stent for symptomatic M1 stenosis of middle cerebral artery. Eur J Radiol 80:e356–e360CrossRefPubMed

15.

Wolfe TJ, Fitzsimmons BF, Hussain SI, Lynch JR, Zaidat OO (2009) Long term clinical and angiographic outcomes with the Wingspan stent for treatment of symptomatic 50-99% intracranial atherosclerosis: single center experience in 51 cases. J Neurointerv Surg 1:40–43CrossRefPubMed

16.

Yu SC, Leung TW, Lee KT, Wong LK (2014) Learning curve of Wingspan stenting for intracranial atherosclerosis: single-center experience of 95 consecutive patients. J Neurointerv Surg 6:212–218CrossRefPubMedPubMedCentral

17.

Zhang L, Huang Q, Zhang Y et al (2013) A single-center study of Wingspan stents for symptomatic atherosclerotic stenosis of the middle cerebral artery. J Clin Neurosci 20:362–366CrossRefPubMed

18.

Zhang L, Huang Q, Zhang Y et al (2012) Wingspan stents for the treatment of symptomatic atherosclerotic stenosis in small intracranial vessels: safety and efficacy evaluation. AJNR Am J Neuroradiol 33:343–347CrossRefPubMed

19.

Chimowitz MI, Lynn MJ, Turan TN et al (2011) Design of the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis trial. J Stroke Cerebrovasc Dis 20:357–368CrossRefPubMedPubMedCentral

20.

Goldstein LB, Bushnell CD, Adams RJ et al (2011) Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:517–584CrossRefPubMed

21.

van Mook WN, Rennenberg RJ, Schurink GW et al (2005) Cerebral hyperperfusion syndrome. Lancet Neurol 4:877–888CrossRefPubMed

22.

Jiang WJ, Srivastava T, Gao F, Du B, Dong KH, Xu XT (2006) Perforator stroke after elective stenting of symptomatic intracranial stenosis. Neurology 66:1868–1872CrossRefPubMed

23.

Gray WA, Yadav JS, Verta P et al (2007) The CAPTURE registry: predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post-approval setting. Catheter Cardiovasc Interv 70:1025–1033CrossRefPubMed

24.

Derdeyn CP, Fiorella D, Lynn MJ et al (2013) Impact of operator and site experience on outcomes after angioplasty and stenting in the SAMMPRIS trial. J Neurointerv Surg 5:528–533CrossRefPubMedPubMedCentral

25.

Jiang WJ, Du B, Leung TW, Xu XT, Jin M, Dong KH (2007) Symptomatic intracranial stenosis: cerebrovascular complications from elective stent placement. Radiology 243:188–197CrossRefPubMed

26.

Miao ZR, Feng L, Li S et al (2009) Treatment of symptomatic middle cerebral artery stenosis with balloon-mounted stents: long-term follow-up at a single center. Neurosurgery 64:79–84, discussion 84-75CrossRefPubMed

27.

Caplan LR, Gorelick PB, Hier DB (1986) Race, sex and occlusive cerebrovascular disease: a review. Stroke 17:648–655CrossRefPubMed

28.

Wong LK (2006) Global burden of intracranial atherosclerosis. Int J Stroke 1:158–159CrossRefPubMed

Title: Outcomes of middle cerebral artery angioplasty and stenting with Wingspan at a high-volume center
Authors: Zi-Liang Wang
Bu-Lang Gao
Tian-Xiao Li
Dong-Yang Cai
Liang-Fu Zhu
Jiang-Yu Xue
Wei-Xing Bai
Zhao-Shuo Li
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 2/2016
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-015-1611-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcomes of middle cerebral artery angioplasty and stenting with Wingspan at a high-volume center

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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