Treatment of high risk symptomatic intracranial atherosclerosis with balloon mounted coronary stents and Wingspan stents: single center experience over a 10 year period

J Neurointerv Surg. 2012 Jan 1;4(1):34-9. doi: 10.1136/jnis.2010.004523. Epub 2011 Jul 28.

Abstract

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.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Angioplasty, Balloon / instrumentation*
  • Angioplasty, Balloon / methods
  • Carotid Stenosis / diagnosis
  • Carotid Stenosis / pathology
  • Carotid Stenosis / surgery
  • Coronary Vessels / pathology
  • Coronary Vessels / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Arteriosclerosis / pathology
  • Intracranial Arteriosclerosis / surgery*
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic / trends
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Stents*
  • Treatment Outcome