4.7 Article

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

Journal

NEUROLOGY
Volume 70, Issue 17, Pages 1518-1524

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/01.wnl.0000306308.08229.a3

Keywords

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Funding

  1. NINDS NIH HHS [P50 NS044378, R01 NS051688, K23 NS054084, K24 NS050307, R01 NS051688-01, K23 NS054084-04, K24 NS050307-04, P50 NS044378-069010] Funding Source: Medline

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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 >= 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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