Wingspan Stenting for Severe Symptomatic Intracranial Atherosclerotic Stenosis in 433 Patients Treated at a Single Medical Center

Tian-Xiao Li, Bu-Lang Gao, Dong-Yang Cai, Zi-Liang Wang, Liang-Fu Zhu, Jiang-Yu Xue, Wei-Xing Bai, Ying-Kun He, Li Li, Tian-Xiao Li, Bu-Lang Gao, Dong-Yang Cai, Zi-Liang Wang, Liang-Fu Zhu, Jiang-Yu Xue, Wei-Xing Bai, Ying-Kun He, Li Li

Abstract

Purpose: To investigate the safety and outcome of intracranial stenting for intracranial atherosclerotic stenosis (IAS).

Materials and methods: Between July 2007 and April 2013, 433 consecutive patients with IAS > 70% underwent intracranial Wingspan stenting, and the data were prospectively analyzed.

Results: Intracranial stenting was successful in 429 patients (99.1%), and the mean stenosis rate was improved from prestenting (82.3 ± 7.6)% to poststenting (16.6 ± 6.6)%. During the 30-day perioperative period, 29 patients (6.7%) developed stroke. The total perioperative stroke rate was significantly (P < 0.01) higher in the basilar artery area than in others, whereas the hemorrhagic stroke rate was significantly (P < 0.05) greater in the middle cerebral artery area than in others. The experience accumulation stage (13%) had a significantly (P < 0.05) higher stroke rate than the technical maturation stage (4.8%). Clinical follow-up 6-69 months poststenting revealed ipsilateral stroke in 20 patients (5.5%). The one- and two-year cumulative stroke rates were 9.5% and 11.5%, respectively; the two-year cumulative stroke rate was significantly (P < 0.05) greater in the experience accumulation stage (18.8%) than in the technical maturation stage (9.1%).

Conclusion: Wingspan stenting for intracranial atherosclerotic stenosis is safe and the long-term stroke rate after stenting is low in a Chinese subpopulation.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Perioperative complications with respect to…
Fig 1. Perioperative complications with respect to the experience accumulation and technical maturation stages.
ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage; FDI, fatal/disabling ischemic stroke; FDH, fatal/disabling hemorrhage.
Fig 2. Kaplan-Meier estimation of the cumulative…
Fig 2. Kaplan-Meier estimation of the cumulative stroke rate.
The analysis ended at 60 months (x-axis) because only two cases had a follow-up duration exceeding 66 months. The one-year cumulative stroke rate (including all cases of stroke or death within the 30-day perioperative period and all cases of ipsilateral stroke after that period) was 9.5% (95% CI: 6.6–12.4%) and the two-year cumulative stroke rate was 11.5% (95% CI: 8.2%–14.8%).
Fig 3. Kaplan-Meier estimation of the cumulative…
Fig 3. Kaplan-Meier estimation of the cumulative stroke rate.
The stroke incidences during the experience accumulation and technical maturation stages have been compared. The former stage yielded a one-year cumulative stroke rate (including all cases of stroke or death within the 30-day perioperative period and all cases of ipsilateral stroke after that period) of 15.7% (95% CI: 8.3–23.1%) and a two-year cumulative stroke rate of 18.8% (95% CI: 10.6–27.0%). The latter stage generated a one-year cumulative stroke rate (including all cases of stroke or death within the 30-day perioperative period and all cases of ipsilateral stroke after that period) of 7.7% (95% CI: 4.8–10.6%) and a two-year cumulative stroke rate of 9.1% (95% CI: 5.8–12.4%). The Kaplan-Meier plots differed significantly according to the log-rank test (X2 = 4.735, p = 0.030). Green curve: Experience accumulation stage. Blue curve: Technical maturation stage.

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