Abstract TP151: Stenting of Symptomatic Intracranial Stenosis Using Balloon Mounted Coronary Stents: A Single Center Experience
Introduction: The SAMMPRIS trial demonstrated that stenting for symptomatic intracranial stenosis (ICS) (70-99%) with the Wingspan system is significantly more dangerous than best medical management. The Wingspan involves a complicated four step deployment procedure; when conversely, the balloon mounted coronary stent (BMCS) is a single step process without the need for an exchange maneuver. Based on our experience, we hypothesize that intracranial stenting with BMCS is a less complicated, clinically viable alternative for patients with symptomatic ICS.
Methods: We performed a retrospective chart review of all patients at our center with symptomatic ICS (defined as >70%) and attempted placement of BMCS (n=37) between 12/2005-6/2012. Pretreatment ICS was measured by conventional cerebral angiography in all cases. Clinical outcomes included peri-procedural stroke or death prior to hospital discharge and all cause stroke or mortality within serial follow-up. Procedural outcomes included complications of stent placement and long-term stent patency. Follow-up was obtained up to 48 months with a mean follow-up of 18.5 months.
Results: BMCS was attempted in 37 patients (14 women, 23 men; age range 30-80 years, mean 60.8 years). There was a 97% technical success rate for the procedure with one patient suffering an asymptomatic MCA dissection. Two patients (5.4%) had small peri-procedural infarcts. There were no peri-procedural deaths. At one year follow-up, there were three non-stroke related deaths (8%), one asymptomatic stent occlusion at three months follow-up and five patients requiring angioplasty for restenosis. There were two late infarcts, one not in distribution of the stent, and one in a patient who was taken off antiplatelet regimen. Angiography in these patients demonstrated stent patency.
Conclusion: This small single center experience suggests that BMCS may be a safer, less complicated, and clinically viable alternative to the Wingspan stent for patients with symptomatic ICS who fail best medical therapy. Further prospective comparative studies of BMCS for symptomatic ICS would be required to verify this experience.
- © 2012 by American Heart Association, Inc.