The NIH registry on use of the Wingspan stent for symptomatic 70-99% intracranial arterial stenosis. Neurology 2008 Apr 22;70(17):1518-24
Date
02/01/2008Pubmed ID
18235078Pubmed Central ID
PMC3506389DOI
10.1212/01.wnl.0000306308.08229.a3Scopus ID
2-s2.0-42549099808 (requires institutional sign-in at Scopus site) 336 CitationsAbstract
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.
Author List
Zaidat OO, Klucznik R, Alexander MJ, Chaloupka J, Lutsep H, Barnwell S, Mawad M, Lane B, Lynn MJ, Chimowitz M, NIH Multi-center Wingspan Intracranial Stent Registry Study GroupMESH terms used to index this publication - Major topics in bold
AgedConstriction, Pathologic
Device Approval
Humans
Intracranial Arteriosclerosis
Kaplan-Meier Estimate
Male
Middle Aged
National Institutes of Health (U.S.)
Randomized Controlled Trials as Topic
Registries
Risk Factors
Stents
Stroke
Treatment Outcome
United States