Wingspan stents for the treatment of symptomatic atherosclerotic stenosis in small intracranial vessels: safety and efficacy evaluation

Abstract

Background and purpose: Until now, endovascular treatment of symptomatic atherosclerotic stenosis in small intracranial arteries (≤2.5 mm) was limited. We evaluated the safety and efficacy of the treatment by using Wingspan stents in arteries of this caliber.

Materials and methods: From March 2007 to July 2010, 53 symptomatic intracranial stenoses with narrowing of at least 50% in 53 patients were treated by using Wingspan stents. Clinical manifestations and imaging features were recorded.

Results: The technical success rate was 98.1%. There were no serious complications, with the exception of 1 patient who experienced a small cerebral hemorrhage caused by perforation of microwire. Thirty-nine patients (74%) were available for follow-up imaging with DSA. ISR was documented in 13 of these patients, including 2 patients with symptomatic ISR. The median length of the vascular lesions was 5.39 mm, and patients whose vascular lesions were longer than 5.39 mm had a much higher incidence of ISR than patients whose vascular lesions were shorter than 5.39 mm (53% versus 15%, respectively). The median ratio of the reference artery diameter to the stent diameter was 0.78, and patients whose ratio was smaller than 0.78 had a much higher incidence of ISR than patients whose ratio was larger than 0.78 (53% versus 15%, respectively).

Conclusions: In our series, percutaneous transluminal angioplasty and stent placement of small intracranial arteries by using Wingspan stents was safe. The ISR rate was relatively high; most patients having ISR were asymptomatic. Further follow-up is needed to assess the long-term efficacy of this procedure.

Fig 1.

A 42-year-old man with a severe stenosis of the right middle cerebral artery (MCA) was referred for evaluation of TIAs recurrent. Diagnostic cerebral angiography confirmed a preocclusive (>75%) stenosis of the right MCA (A, arrow). The patient underwent percutaneous transluminal angioplasty and stent placement with Wingspan. The subtracted image demonstrates near-complete resolution of the stenosis (B, arrow). The patient's ischemic symptoms immediately resolved. The 6-month follow-up angiogram shows continued patency of the stented segment (C).

Fig 2.

A 60-year-old woman underwent percutaneous transluminal angioplasty and stent placement with Wingspan for a symptomatic basal artery stenosis with TIAs despite taking aspirin and clopidogrel (A and B, arrows). The patient's ischemic symptoms completely resolved after the procedure. The 17-month follow-up angiogram demonstrates there was no ISR (C).