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Ischemic stroke
Case series
MRI audit of complications in intracranial stenosis treated with Wingspan device
  1. Leonard L L Yeo1,
  2. Y M Wu2,3,
  3. Y L Chen3,4,
  4. C H Yeh2,3,
  5. T H Lee3,5,
  6. H F Wong2,3
  1. 1Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
  2. 2Division of Neuroradiology, Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
  3. 3College of Medicine and School of Medical Technology, Chang Gung University; Taoyuan, Taiwan
  4. 4Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan
  5. 5Department of Neurology, Stroke Center, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
  1. Correspondence to A/Professor Wong Ho-Fai, No. 5, Fuxing Street, Guishan Township, Taoyuan City 333, Taiwan; hfwong{at}cgmh.org.tw

Abstract

Objectives To evaluate the safety and efficacy of the Wingspan device for the treatment of symptomatic intracranial atherosclerotic stenosis (ICAS).

Methods We audited a prospective ongoing database of consecutive patients who received Wingspan stenting between January 2013 and December 2015. All patients underwent MRI to audit any complications during the early follow-up period. We focused on the clinical demographics, lesion characteristics, treatment results, and periprocedural complications. Functional outcomes were measured with the modified Rankin Scale (mRS) at discharge and after 3 months.

Results Intracranial stenting was performed in 50 patients (100%). Mean stenosis pre-stenting was 76.5±13.1% and post-stenting residual stenosis was 19.8±13.8%. The overall 30-day rate of procedure-related complications was 6.0% (3/50). Two patients (4%) developed in-stent restenosis, one of whom had a dissection at the middle cerebral artery. Interestingly, on the follow-up MRI scan there was a high incidence of asymptomatic diffusion-weighted imaging (DWI) hyperintensities, 46% (23/50) presumed to be due to microembolic causes. At the 90-day, 180-day, and 1-year follow-up, three patients had further strokes resulting in a total complication rate of 12%. 92% had excellent outcomes (mRS 0–1) and only one patient had deterioration of his mRS score.

Conclusions ICAS treated by Wingspan stenting using pre-placement balloon angioplasty appears safe and effective with a high technical success rate and favorable outcomes. There is a high incidence of asymptomatic DWI hyperintensites post-procedure, but these do not appear to result in long-term sequelae.

  • Embolic
  • Stent
  • Stroke
  • MRI
  • Complication

https://doi.org/10.1136/neurintsurg-2016-012799

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    Footnotes

    • Contributors HFW and LLLY contributed equally to this work. LLLY designed the study and collected the data, analysed the data and drafted and revised the paper. YMW and YLC helped in the design of the study, contributed data to the study and revised the paper. CHY helped in data analysis and contributed data to the study. THL revised the draft and contributed to study design. HFW monitored data, provided data to the study, revised the draft and helped in data analysis.

    • Competing interests None declared.

    • Ethics approval Ethical approval for this project was obtained from the institutional review board of Linkou Chang Gung Memorial Hospital.

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