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. 2008 Apr 22;70(17):1518-24.
doi: 10.1212/01.wnl.0000306308.08229.a3. Epub 2008 Jan 30.

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

O O Zaidat  1 , R Klucznik, M J Alexander, J Chaloupka, H Lutsep, S Barnwell, M Mawad, B Lane, M J Lynn, M Chimowitz; NIH Multi-center Wingspan Intracranial Stent Registry Study Group
Collaborators, Affiliations

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

O O Zaidat et al. Neurology. .

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.

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Figures

Figure 1
Figure 1. Symptomatic proximal basilar artery stenosis
Symptomatic proximal basilar artery stenosis with 80% stenosis and 35% residual stenosis on the immediate post stenting result, and 40% on 4 months angiographic follow-up.
Figure 2
Figure 2
A Kaplan-Meier curve for the outcome stroke or death within 30 days or stroke in the territory after 30 days among Wingspan registry patients with ≥70% stenosis prior to stenting
Figure 3
Figure 3. Kaplan-Meier curves
Kaplan-Meier curves showing a comparison of Warfarin-Aspirin Symptomatic Intracranial Disease patients (n = 122) with Wingspan registry patients (n = 86) with the high-risk entrance criteria of 70% to 99% stenosis and TIA or stroke within 30 days prior to study entry for the outcome stroke or death within 30 days or stroke in the territory after 30 days.
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