Purpose: The purpose of this study is to investigate the treatment results, and procedure-related complications of stent-angioplasty for symptomatic intracranial.

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Presentation transcript:

Purpose: The purpose of this study is to investigate the treatment results, and procedure-related complications of stent-angioplasty for symptomatic intracranial arterial stenosis with Wingspan stent and Gateway balloon. Materials & Methods: From May to May 2015, 76 patients (52 males, 24 females, mean age: 66.6±8.9 years) with symptomatic intracranial arterial stenosis were treated. Inclusion criteria are acute and/or subacute symptomatic infarction or repeated transient ischemic attack (TIA) (infarction vs. TIA: 39 vs. 37) and severe stenosis related to symptoms confirmed with catheter angiography. The numbers of stenotic lesions were 29 cases on ICA, 34 on MCA, and 13 on vertebrobasilar (V-B) artery. All of the used stents for treatment were Wingspan self-expanding stent and Gateway balloon. Mean NIHSS at admission was 1.4±1.9, and mean stenosis rate was 76.8±6.2%. Clinical status (including NIHSS) and angiographic results were assessed retrospectively. Results: Stents were successfully deployed at first trial in almost all cases except only two cases due to tortuous ICA course (97.4%), and in one case successful stenting was done at second trial (98.7%). Periprocedural complications occurred in 11 cases (14.5%), and symptomatic cases were only 6 (7.9%, transient vs. permanent: 4 vs. 2 (5.3% vs. 2.6%). Of 76 cases 67 were followed clinically over 6 months (88.2%) and the mean follow-up period was 25.8±20.0 months). Angiographic follow-up was performed in 57 cases (75.0%. 13.9±11.8 months). The mean NIHSS after stent-angioplasty was 0.8±1.7 and 0.5±1.7 at last clinical follow-up day. Post-stenting residual stenosis was 8.7±13.0%, and 14.8±25.3% at last angiographic follow up. In-stent restenosis over 50% occurred in 7 cases (7/57, 12.3%), and 6 cases were retreated successfully with Gateway balloon (3) or Drug-eluting balloon (3). Symptomatic infarctions were occurred in 4 of 76 (5.3%) patients during the clinical follow-up period. Conclusion: Stent-angioplasty with Wingspan self-expanding stent appeared to be safe and effective for intracranial arterial stenotic disease. However, it should prompt more strict selection criteria and desperate angiographic follow-up for better clinical results. Result of Stent-Angioplasty with Wingspan Stent for Symptomatic Intracranial Stenosis Seung-Hoon You, M.D., Department of Neurosurgery 1), Neurology 2), Radiology 3), Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea Groups No Restenosis (N=51) Restenosis (N=7) Difference Age67.5± ±10.1P=0.853 Lesions ICA=21 MCA=20 VB=10 ICA=0 MCA=7 VB=0 P=0.047 Stenosis Rate (%) Preop76.5± ±4.8P=0.014 Postop6.1± ±8.4P=0.523 FU6.6± ±14.6P=0.000 FU interval (months)14.5± ±3.9P=0.322 NIHSS Preop0.9±1.42.1±0.4P=0.000 Postop0.3±0.91.0±0.6P=0.017 FU0.1±0.20.1±0.4P=0.420 Table 1. Analysis according to the occurrence of in-stent restenosis. Table 2. Analysis according to the lesions. Figure 1-1. dMRI and MRA of 66-year-old male patient. Fig Pre-, post-angioplasty and 13mo FU angiograms. Fig CTA, Pre- & post-angioplasty angiograms of 50-y old male patient Fig In-stent restenosis occurred 5mo after 1 st stent-angioplasty. However, repeated restenosis occurred 6mo after 2 nd Tx. Fig Fourteen months after 3 rd Tx with DEB, restenosis did not occur and even more dilated lumen was seen.