Elsevier

Surgical Neurology

Volume 72, Issue 6, December 2009, Pages 607-611
Surgical Neurology

Ischemia
Intracranial angioplasty with Gateway-Wingspan system for symptomatic atherosclerotic stenosis: preliminary results of 27 Chinese patients

https://doi.org/10.1016/j.surneu.2009.06.017Get rights and content

Abstract

Background

We investigated the safety of treatment of symptomatic intracranial atherosclerotic stenoses with the Gateway-Wingspan system and its initial effect on prevention of ischemic events.

Methods

Twenty-seven cases of symptomatic intracranial atherosclerotic stenoses were treated with angioplasty with a Wingspan stent. Location of stenoses, extent of stenoses before and after angioplasty, success rate of treatment, occurrence of procedural complications, and changes in recurrence of symptoms of ischemic events 30 days after treatment were recorded.

Results

Twenty-nine angioplasties with the Wingspan system were successfully carried out in 29 stenoses in 27 patients. Of 29 stenoses, 17 were in the posterior circulation, and 12, in the anterior circulation. The degree of stenoses was reduced from baseline 71.8% (56%-87.8%) to 24.9% (0%-45%) after stenting. Complications were seen in four patients (14.8%), 3 of which were lesion-related infarction of a perforated artery, and 1 was a non-lesion-related infarction. Two complications led to transient neurologic dysfunction, one led to defect of the visual field, and one led to hemiplegia. The prevalence of morbidity and serious morbidity were 7.4% and 3.7%, respectively, and no death occurred. No new ischemic events happened during 30 days after stenting.

Conclusion

Angioplasty with the Wingspan system to treat symptomatic intracranial atherosclerotic stenoses appears to be safe. Its initial effect on prevention of ischemic events is acceptable.

Introduction

Intracranial atherosclerotic stenosis is a main cause of acute stroke or TIA, and its prevalence differs between races [18]. A higher prevalence in Chinese subjects was reported [5], [9], [22]. The prognosis of patients with serious intracranial atherosclerotic stenosis was poor [4]. A high risk of ischemic events was noted even if patients were taking aspirin and warfarin, and the prevalence increased with stenosis severity [2], [4], [16], [21]. Angioplasty with or without stents is recommended for serious intracranial atherosclerotic stenosis. Several studies have shown that recurrence rates for patients with intracranial atherosclerotic stenosis decreased after angioplasty with a balloon or balloon-mounted stent [10], [11], [15], but these procedures were associated with a high prevalence of complications (eg, vessel injury) [7], [14].

The Gateway-Wingspan system uses a self-expandable stent to treat intracranial stenosis. Initial results indicated that it was safe and effective with an acceptable prevalence of complications and mortality [3], [6], [8]. The present study details the initial experiences and preliminary results after its use in Chinese patients with intracranial stenosis at our institution and after it was introduced in Chinese hospitals in April 2007.

Section snippets

Patients and methods

This was a retrospective review study. Twenty-seven patients (age, 36-71 years; mean, 60.1 years) with intracranial atherosclerotic stenoses received angioplasty with the Wingspan stent system in Tangdu Hospital (Xian, China) from May to October 2007. All subjects had a history of ischemic events before treatment. Fourteen patients presented with TIA including paroxysmal aphasia or hemiplegia, 9 patients presented with acute stroke but recovered well after taking medication, and 4 patients had

Results

Twenty-nine lesions in 27 patients were revascularized with 29 Gateway-Wingspan stent systems. Sixteen stenoses of the vertebra basilar artery in 15 patients were treated with 16 Wingspan stents; 9 stenoses of the middle cerebral artery in 9 patients were treated with nine Wingspan stents; and stenoses of the middle cerebral artery and basilar artery in 1 patient were treated with two Wingspan stents. The Gateway balloons crossed stenoses smoothly in all patients and there was no dissection

Discussion

Cerebrovascular disease is one of the main causes of death worldwide. In the United States, about 700 000 patients are diagnosed with ischemic stroke every year [1], whereas up to 1.5 million are diagnosed with the same condition in China [19]. For whites, about 8% to 10% of cases of acute infarction are caused by intracranial atherosclerotic stenosis [18]. The prevalence is as high as 33% in Chinese subjects [22]. The cause was intracranial stenosis in nearly 50% of Chinese patients presenting

Conclusion

Angioplasty with a Wingspan system to treat symptomatic intracranial atherosclerotic stenoses appears to be safe, with acceptable morbidity and mortality. Its initial effect on prevention of ischemic events is acceptable, and the long-term effect needs investigation. Preliminary results in a small patient population did not show obvious superiority of the Wingspan stent compared with a balloon-mounted stent.

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