CHICAGO — Patients with symptomatic intracranial atherosclerosis can be treated successfully and with a relatively low rate of procedural complications with a new stent system designed specifically for this indication, according to Dr. Aquilla Turk, who presented his findings at the annual meeting of the American Society of Neuroradiology.
The stent system provides patients who have medically refractory atherosclerotic stenosis with a new treatment option other than medical therapy.
Over a 1-year period, 134 symptomatic patients (average age 63.2 years, 59% male) with 142 lesions underwent angioplasty and stenting with the Gateway balloon- Wingspan stent system. The Wingspan is a flexible, self-expanding, microcatheter-delivered microstent that is manufactured by Boston Scientific Corp. (Natick, Mass.).
About 57% of the patients presented initially with a stroke. At baseline, the average stenosis was 75%. After angioplasty with the balloon, average stenosis fell to 43% and then dropped to 28% upon stent placement, said Dr. Turk, a radiologist affiliated with the University of Wisconsin, Madison.
Dr. Turk is one of the investigators from five different centers who is participating in the Neuroendovascular Research Collaboration.
Stents were placed with a 98% first-session success rate. Treated lesions were located in the internal carotid (46 lesions) and the vertebral (29 lesions), basilar (30 lesions), and middle cerebral (37 lesions) arteries.
The periprocedural stroke and death rate was 4.9%, which compares favorably with that of angioplasty alone, said Dr. Turk.
Two-thirds of the patients (88) were followed for 3–6 months. Of these 88 patients, 10 had other events, of which 4 were attributed to antiplatelet medication discontinuation, either because of patient noncompliance or because of other physician's orders.
Imaging follow-up was available for 90 lesions. Of those lesions, 32 demonstrated in-stent restenosis or occlusion, and 10 were symptomatic.
Of the 10 patients who had symptomatic restenosis, only 2 went on to have subsequent stroke or died.
Eleven of the 32 lesions were retreated, and in-stent dissections were discovered in three of these patients. Two of the dissections required placement of an additional Wingspan stent and one patient had a reperfusion hemorrhage after retreatment.
“Intracranial atherosclerosis accounts for about 40,000–60,000 cases of new stroke reported in the U.S. each year,” said Dr. Turk, who noted that “an acceptable surgical therapy has not been found.”
The Wingspan registry is funded by an unrestricted grant from Boston Scientific. Dr. Turk is a researcher and consultant for Boston Scientific.
Significant stenosis of the right middle cerebral artery is seen with abnormally long transit time.
Imaging shows right middle cerebral artery normalization following stenting with the Wingspan system. Photos courtesy Dr. Aquilla Turk