on October 16, 2008
Published online before print October 16, 2008, doi: 10.1161/STROKEAHA.108.525774
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Submitted on May 13, 2008
From Departments of Neurosurgery and Neuroradiology (D.J.F., P.A.R., T.J.M.), Cleveland Clinic Foundation, Cleveland, Ohio; Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center (E.I.L., L.N.H.), School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, NY; Departments of Radiology and Neurosurgery (A.S.T.), Medical University of South Carolina, Charleston, SC; Department of Neurosurgery (F.C.A., C.G.M.), Barrow Neurological Institute, Phoenix, Ariz; Departments of Neurosurgery and Neuroradiology (L.P., B.G.W., P.D.P.), University of Texas Southwestern, Dallas, Tex; Departments of Neurological Surgery and Radiology (H.H.W.), University at Stony Brook, State University of New York, Stony Brook, NY; Departments of Neurosurgery and Neuroradiology (D.N., B.A.-K.), University of Wisconsin, Madison, Wisc. * To whom correspondence should be addressed. E-mail: david.fiorella{at}bnaneuro.net.
Background and Purpose—In-stent restenosis (ISR) occurs in approximately one-third of patients after the percutaneous transluminal angioplasty and stenting of intracranial atherosclerotic lesions with the Wingspan system. We review our experience with target lesion revascularization (TLR) for ISR after Wingspan treatment. Methods—Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions in our US Wingspan Registry. ISR was defined as >50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent and >20% absolute luminal loss. Results—To date, 36 patients in the registry have experienced ISR after percutaneous transluminal angioplasty and stenting with Wingspan. Of these patients, 29 (80.6%) have undergone TLR with either angioplasty alone (n=26) or angioplasty with restenting (n=3). Restenting was performed for in-stent dissections that occurred after the initial angioplasty. Of the 29 patients undergoing TLR, 9 required Conclusions—TLR can be performed for the treatment of intracranial Wingspan ISR with a relatively high degree of safety. However, the TLR results are not durable in
Accepted on May 28, 2008
Target Lesion Revascularization After Wingspan. Assessment of Safety and Durability
David J. Fiorella MD, PhD*;
1 interventions for recurrent ISR, for a total of 42 interventions. One major complication, a postprocedural reperfusion hemorrhage, was encountered in the periprocedural period (2.4% per procedure; 3.5% per patient). Angiographic follow-up is available for 22 of 29 patients after TLR. Eleven of 22 (50%) demonstrated recurrent ISR at follow-up angiography. Nine patients have undergone multiple retreatments (2 retreatments, n=6; 3 retreatments, n=2; 4 retreatments, n=1) for recurrent ISR. Nine of 11 recurrent ISR lesions were located within the anterior circulation. The mean age for patients with recurrent anterior circulation ISR was 57.9 years (vs 81 years for posterior circulation ISR).
50% of patients, and multiple revascularization procedures may be required in this subgroup.
Key words: intracranial atherosclerotic disease • poststenting in-stent restenosis • target lesion revascularization • Wingspan stent system
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