The NIH registry on use of the Wingspan stent for symptomatic 70-99% intracranial arterial stenosis.

Abstract

BACKGROUND The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial showed that patients with symptomatic 70% to 99% intracranial arterial stenosis are at particularly high risk of ipsilateral stroke on medical therapy: 18% at 1 year (95% CI = 3% to 24%). The Wingspan intracranial stent is another therapeutic option but there are limited data on the technical success of stenting and outcome of patients with 70% to 99% stenosis treated with a Wingspan stent. METHODS Sixteen medical centers enrolled consecutive patients treated with a Wingspan stent in this registry between November 2005 and October 2006. Data on stenting indication, severity of stenosis, technical success (stent placement across the target lesion with <50% residual stenosis), follow-up angiography, and outcome were collected. RESULTS A total of 129 patients with symptomatic 70% to 99% intracranial stenosis were enrolled. The technical success rate was 96.7%. The mean pre and post-stent stenoses were 82% and 20%. The frequency of any stroke, intracerebral hemorrhage, or death within 30 days or ipsilateral stroke beyond 30 days was 14.0% at 6 months (95% CI = 8.7% to 22.1%). The frequency of >or=50% restenosis on follow-up angiography was 13/52 (25%). CONCLUSION The use of a Wingspan stent in patients with severe intracranial stenosis is relatively safe with high rate of technical success with moderately high rate of restenosis. Comparison of the event rates in high-risk patients in Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) vs this registry do not rule out either that stenting could be associated with a substantial relative risk reduction (e.g., 50%) or has no advantage compared with medical therapy. A randomized trial comparing stenting with medical therapy is needed.

DOI: 10.1212/01.wnl.0000306308.08229.a3

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@article{Zaidat2008TheNR, title={The NIH registry on use of the Wingspan stent for symptomatic 70-99% intracranial arterial stenosis.}, author={Osama O . Zaidat and Richard Klucznik and Michael J. Alexander and J. Chaloupka and Helmi L . Lutsep and Stanley L. Barnwell and Michael E Mawad and Brian K Lane and Michael Lynn and Marc I . Chimowitz}, journal={Neurology}, year={2008}, volume={70 17}, pages={1518-24} }