Related Experiment Video
Updated: Jul 2, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Angiographic patterns of Wingspan in-stent restenosis
Felipe C Albuquerque1, Elad I Levy, Aquilla S Turk
1Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Insights
In-stent restenosis (ISR) after Wingspan stenting for intracranial disease often presents as focal lesions. However, over half of these ISR cases are more severe than the initial lesion, particularly in the internal carotid and middle cerebral arteries.
Area of Science:
- Neuroendovascular intervention
- Cerebrovascular disease
- Interventional neuroradiology
Background:
- In-stent restenosis (ISR) is a known complication following coronary angioplasty with stenting.
- The Wingspan stent is used for treating intracranial atherosclerotic disease.
- Characterization of ISR after Wingspan stenting is crucial for understanding treatment outcomes.
Purpose of the Study:
- To modify and apply a classification system for in-stent restenosis (ISR).
- To describe the appearance and distribution of ISR after Wingspan intracranial stenting.
- To compare ISR characteristics with the original lesions treated.
Main Methods:
- Prospective, intention-to-treat, multicenter registry of Wingspan treatments.
- Clinical and angiographic follow-up data collection.
- ISR defined as >50% stenosis or >20% absolute luminal loss; classified by pattern, location, and severity.
Main Results:
- ISR or stent occlusion occurred in 32.3% of 127 treated lesions.
- Focal ISR (61.0%) was more common than diffuse (26.8%) or occluded (3.9%) lesions.
- Over half of ISR lesions were more severe (length or stenosis) than original lesions, especially in supraclinoid ICA and MCA.
Conclusions:
- Wingspan ISR typically manifests as a focal lesion.
- ISR severity or length often exceeds that of the original lesion.
- Supraclinoid internal carotid artery and middle cerebral artery ISR are prone to increased severity.
Objective:
A classification system developed to characterize in-stent restenosis (ISR) after coronary percutaneous transluminal angioplasty with stenting was modified and applied to describe the appearance and distribution of ISR occurring after Wingspan (Boston Scientific, Fremont, CA) intracranial percutaneous transluminal angioplasty with stenting.
Methods:
A prospective, intention-to-treat, multicenter registry of Wingspan treatment for symptomatic intracranial atherosclerotic disease was maintained. Clinical and angiographic follow-up results were recorded. ISR was defined as greater than 50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent(s) and greater than 20% absolute luminal loss. ISR lesions were classified by angiographic pattern, location, and severity in comparison with the original lesion treated.
Results:
Imaging follow-up (3-15.5 months) was available for 127 intracranial stenotic lesions treated with Wingspan percutaneous transluminal angioplasty with stenting. Forty-one lesions (32.3%) developed either ISR (n = 36 [28.3%]) or complete stent occlusion (n = 5 [3.9%]) after treatment. When restenotic lesions were characterized using the modified classification system, 25 of 41 (61.0%) were focal lesions involving less than 50% of the length of the stented segment: three were Type IA (focal stenosis involving one end of the stent), 21 were Type IB (focal intrastent stenosis involving a segment completely contained within the stent), and one was Type IC (multiple noncontiguous focal stenoses). Eleven lesions (26.8%) demonstrated diffuse stenosis (>50% of the length of the stented segment): nine were Type II with diffuse intrastent stenosis (completely contained within the stent) and two were Type III with proliferative ISR (extending beyond the stented segment). Five stents were completely occluded at follow-up (Type IV). Of the 36 ISR lesions, 16 were less severe or no worse than the original lesion with respect to severity of stenosis or length of the segment involved; 20 lesions were more severe than the original lesion with respect to the segment length involved (n = 5), actual stenosis severity (n = 6), or both (n = 9). Nine of 10 supraclinoid internal carotid artery ISR lesions and nine of 13 middle cerebral artery ISR lesions were more severe than the original lesion.
Conclusion:
Wingspan ISR typically occurs as a focal lesion. In more than half of ISR cases, the ISR lesion was more extensive than the original lesion treated in terms of lesion length or stenosis severity. Supraclinoid internal carotid artery and middle cerebral artery lesions have a propensity to develop more severe posttreatment stenosis.