The NIH registry on use of the Wingspan stent for symptomatic 70-99% intracranial arterial stenosis
O O Zaidat, 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, Marc Chimowitz, Bethany Lane, Michael Lynn, Seegar Swanson, Osama O Zaidat, Michel Torbey, Brian-Fred Fitzsimmons, Joanna Delap, Richard Klucznik, David Chui, Denise Meyer, Michael J Alexander, Carmelo Graffagnino, Joanna Stoner, John Chaloupka, Cindy George, Helmi Lutsep, Stan Barnwell, Michel E Mawad, Hesham Morsi, Sheila R Moore, Marc Chimowitz, Bethany Lane, Frank Tong, Scott Kasner, Robert Hurst, John Weigele, Brett Cucchiara, Steven Messe, Joshua Levine, Qaisar Shah, Franklin Marden, Richard Pergolizzi, Christopher Putman, Laura Buhler, Y Pierre Gobin, Howard A Riina, Kimberly Salvaggio, Matthew Fink, Dana Leifer, Igor Ougorets, Alan Segal, David S Liebeskind, Gary R Duckwiler, Susan W Yun, Walter S Lesley, Brandie Ciceri, Brian H Wulbrecht, Robbie J Lam, Marcella Wozniak, Abraham Obuchowski, Karen Yarbrough, Carol Greenwald, Ronald Budzik, Molly Dole, Robert Wytek, Kiernan Murphy, O O Zaidat, 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, Marc Chimowitz, Bethany Lane, Michael Lynn, Seegar Swanson, Osama O Zaidat, Michel Torbey, Brian-Fred Fitzsimmons, Joanna Delap, Richard Klucznik, David Chui, Denise Meyer, Michael J Alexander, Carmelo Graffagnino, Joanna Stoner, John Chaloupka, Cindy George, Helmi Lutsep, Stan Barnwell, Michel E Mawad, Hesham Morsi, Sheila R Moore, Marc Chimowitz, Bethany Lane, Frank Tong, Scott Kasner, Robert Hurst, John Weigele, Brett Cucchiara, Steven Messe, Joshua Levine, Qaisar Shah, Franklin Marden, Richard Pergolizzi, Christopher Putman, Laura Buhler, Y Pierre Gobin, Howard A Riina, Kimberly Salvaggio, Matthew Fink, Dana Leifer, Igor Ougorets, Alan Segal, David S Liebeskind, Gary R Duckwiler, Susan W Yun, Walter S Lesley, Brandie Ciceri, Brian H Wulbrecht, Robbie J Lam, Marcella Wozniak, Abraham Obuchowski, Karen Yarbrough, Carol Greenwald, Ronald Budzik, Molly Dole, Robert Wytek, Kiernan Murphy
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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Source: PubMed