Impact of WASID and Wingspan on the frequency of intracranial angioplasty and stenting at a high volume tertiary care hospital
- 1Division of Cerebrovascular and Endovascular Neurosurgery, Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
- 2Department of Neurosurgery, Royal University Hospital, Saskatchewan, Canada
- 3Qualitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
- 4Departments of Neurosurgery and Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona, USA
- Correspondence to Dr D Fiorella, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA; david.fiorella{at}bnaneuro.net
- Received 1 April 2009
- Revised 15 May 2009
- Accepted 10 July 2009
Abstract
Background and Purpose The impact of the Warfarin and Aspirin for Symptomatic Intracranial Disease (WASID) data is described in combination with the commercial release of the Wingspan stenting system on the frequency of neurointervention for the treatment of symptomatic intracranial atherosclerotic disease (ICAD) in a tertiary care center.
Methods Endovascular case logs were reviewed from April 2004 to July 2007. The total number of intracranial neurointerventions and the number of neurointerventions (percutaneous transluminal angioplasty alone (PTA) or with stenting (PTAS)) performed for symptomatic ICAD were calculated. The time period evaluated was divided into two equal 19.5-month epochs representing the time periods before and after the availability of the Wingspan system.
Results The frequency of neurointerventions for ICAD increased by 763%, from seven of 354 total cases (2%) to 56 of 367 total cases (15.3%) (p<0.001) after the Wingspan system became available. The increase in intracranial PTAS volume occurred immediately and was stable throughout the “Wingspan era”.
Conclusions The publication of the WASID trial results combined with the availability of the Wingspan stent system led to a marked increase in the frequency of neurointervention for symptomatic ICAD at our institution. The adoption of this technology occurred without direct evidence that PTAS with Wingspan is superior to traditional medical therapy. These findings underscore the need for a randomized trial of stenting and medical therapy for the treatment of this disease process.
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Footnotes
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Funding National Institute of Health.
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Competing interests DF received National Institute of Health funding for the SAMMPRIS trial.
