Treatment of high risk symptomatic intracranial atherosclerosis with balloon mounted coronary stents and Wingspan stents: single center experience over a 10 year period
- Nicholas Tarlov1,
- Reza Jahan2,
- Jeffrey L Saver2,
- James W Sayre2,
- Latisha K Ali2,
- Doojin Kim2,
- Gary R Duckwiler2,
- Satoshi Tateshima2,
- Fernando Viñuela2,
- David S Liebeskind2
- 1Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- 2UCLA Medical Center, Los Angeles, California, USA
- Correspondence to Dr Nicholas Tarlov, 820 Harrison Ave, FGH 3, Boston University School of Medicine, Boston MA 02118, USA;
- Received 22 December 2010
- Revised 14 March 2011
- Accepted 20 March 2011
- Published Online First 28 July 2011
Background Stenting of symptomatic intracranial atherosclerosis remains under investigation, yet this option to potentially avert subsequent stroke has been offered at select centers under humanitarian device exemption and off-label use for several years.
Methods Retrospective case series of consecutive patients undergoing stenting with Wingspan and balloon mounted coronary stents for symptomatic intracranial atherosclerosis at a single institution. Recurrent symptomatic ischemia in the territory of the stented artery was ascertained. Rates of recurrent ischemic stroke were calculated per patient-year of follow-up and were compared with medically treated patients in the Warfarin–Aspirin Symptomatic Intracranial Disease (WASID) trial.
Results During the 10 year study period, 41 cases of intracranial stenting were identified. Stenoses were severe (>70%) in 88% of patients. Stenting procedures occurred a median of 14 days from the most recent symptomatic event. 19 Wingspan stents and 22 balloon mounted coronary stents were deployed. Four strokes occurred within 24 h of stenting, seven within 1 month and eight within 3 months. By 3 months after stenting, no further strokes occurred during up to 2 years of follow-up. Patients had 0.194 ischemic strokes per person-year of follow-up, compared with 0.083 ischemic strokes per person-year of follow-up in the aspirin arm of WASID and 0.065 ischemic strokes per person-year of follow-up in the warfarin arm of WASID.
Conclusions Stenting of symptomatic intracranial atherosclerosis in a high risk subset of cases with advanced degree of luminal stenosis may be associated with an increased early risk of recurrent ischemic stroke.
Competing interests None.
Ethics approval This study was conducted with the approval of the UCLA.
Provenance and peer review Not commissioned; externally peer reviewed.