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Long-term Outcome of Angioplasty Using a Wingspan Stent, Post-Stent Balloon Dilation and Aggressive Restenosis Management for Intracranial Arterial Stenosis

  • Seong-Cheol Park
  • Su Hee Cho
  • Moon-Kyu Kim
  • Ji-Eun Kim
  • Woo-Young Jang
  • Moon-Kyu Lee
  • Kwang-Deog Jo
  • Seung-Hoon YouEmail author
Original Article

Abstract

Purpose

To investigate the long-term outcome of stent angioplasty for symptomatic severe intracranial artery stenosis.

Method

In this study 95 consecutive patients with intracranial atherosclerotic stenosis (>70%) underwent stent angioplasty using Wingspan stents. The primary endpoints were stroke or death within 30 days of the procedure and subsequent stroke attributed to the stented vessel. Disabling stroke was defined as stroke with a modified Rankin scale > 3. Secondary endpoints included transient ischemic attacks, contralateral stroke, nonstroke death, and other events. Patients underwent prestent balloon dilation with or without poststent balloon dilation, close restenosis follow-up, and selective retreatment, as required.

Result

The mean follow-up duration was 34.9 ± 23.3 months. Primary endpoint events occurred in 23% of the patients. The median infarction volume was 2.6 ml, and 11 (68%) of 16 infarctions were <5 ml in volume. Disabling stroke occurred in 3% of patients. The primary endpoint rates were 17.9% within 30 days and 2.1% from 30 days to 1 year. Secondary endpoint events occurred in 27.3% of the patients. Mean stenosis was reduced from 76.8 ± 6.1% to 7.5 ± 13.4%. Of 80 patients who underwent angiographic follow-up, 11 (14%) experienced restenosis (≥50%) and 7 (9%) exhibited restenosis-related symptoms of transient ischemic attack. The rate of symptomatic restenosis was significantly higher in patients who underwent prestent balloon dilation alone than in patients who underwent prestent and poststent balloon dilation (p = 0.016).

Conclusion

The postprocedural stroke rate was similar to that observed in the SAMMPRIS study. Symptomatic restenosis may be reduced by poststent dilation, close angiographic follow-up, and retreatment.

Keywords

Intracranial atherosclerosis Infarction Ischemic attack, transient Retreatment Stroke 

Abbreviations

DSA

Digital subtraction angiography

PreB

Prestent ballooning

PrePostB

Prestent and poststent ballooning

TIA

Transient ischemic attack

Notes

Acknowledgements

This study was supported by Gangneung Asan Hospital research grant 2018-b09.

Author Contribution

All authors made substantial contribution to the design of the study and analysis and interpretation of the data in this work. All authors drafted and/or critically revised the manuscript, provided final approval of the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Compliance with ethical guidelines

Conflict of interest

S.-C. Park, S.H. Cho, M.-K. Kim, J.-E. Kim, W.-Y. Jang, M.-K. Lee, K.-D. Jo and S.-H. You declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Written patient consent was waived by the local ethics committee due to the retrospective design. Gangneung Asan Hospital Institutional Review Board (certification number: 010-3595-9706).

Supplementary material

62_2019_793_MOESM1_ESM.docx (449 kb)
Temporal trends of primary endpoint events and disabling strokes.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryGangneung Asan Hospital, University of Ulsan College of MedicineGangneung, Gangwon-doKorea (Republic of)
  2. 2.Department of NeurologyGangneung Asan Hospital, University of Ulsan College of MedicineGangneungKorea (Republic of)

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