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J NeuroInterv Surg doi:10.1136/jnis.2009.000505
  • Neuroimaging

DynaCT evaluation of in-stent restenosis following Wingspan stenting of intracranial stenosis

  1. S I Moskowitz1,
  2. M E Kelly2,
  3. J Haynes3,
  4. D Fiorella4
  1. 1Division of Cerebrovascular and Endovascular Neurosurgery, Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Department of Neurosurgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada
  3. 3Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, New York, USA
  1. Correspondence to
    David Fiorella, Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, NY 11794, USA; dfiorella{at}notes.cc.sunysb.edu
  • Received 1 April 2009
  • Revised 18 June 2009
  • Accepted 21 July 2009
  • Published Online First 16 September 2009

Abstract

Objective and importance To describe the use of DynaCT angiographic imaging for the evaluation of Wingspan in-stent restenosis (ISR).

Methods Two patients were treated with Wingspan stenting and percutaneous transluminal angioplasty (Patient 1 had treatment of a severe stenosis of the right middle cerebral artery and patient 2 had severe stenosis of the left intracranial internal carotid artery. Both patients developed ISR and were evaluated with high resolution DynaCT angiographic imaging.

Results DynaCT demonstrated circumferential soft tissue density material distributed within the stent as the cause of the stenosis visualized with conventional angiography.

Conclusions These findings support the hypothesis that ISR is caused by neointimal proliferation, rather than vascular re-coil with stent collapse.

Keywords:

Footnotes

  • Funding Dr Fiorella has NIH funding for the SAMMPRIS trial. Other Funders: NIH.

  • Competing interests DF (Boston Scientific, Research Support for US Wingspan Registry).

  • Ethics approval The images were obtained within the setting of routine patient care. No patient identifiers were included. While the available images of Wingpsan ISR are novel/unique, the disease process is not.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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