Related Experiment Videos
Outcome of patients with ≥70% symptomatic intracranial stenosis after Wingspan stenting
Wei-Jian Jiang1, Wengui Yu, Bin Du
1Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Beijing, China 100050. cjr.jiangweijian@vip.163.com
Insights
Wingspan stenting for severe intracranial stenosis showed a lower 1-year risk of stroke or death compared to antithrombotic therapy alone. Further randomized trials are needed to confirm this benefit in high-risk patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Limited long-term outcome data exist for patients with symptomatic severe intracranial atherosclerotic stenosis (≥70%) treated with Wingspan stenting.
- The Warfarin and Aspirin for Symptomatic Intracranial Atherosclerotic Disease (WASID) trial provides a historical control for antithrombotic therapy alone.
Purpose of the Study:
- To evaluate the long-term outcome of Wingspan stenting in patients with symptomatic intracranial atherosclerotic stenosis (≥70%).
- To test the hypothesis that stenting offers no benefit over antithrombotic therapy alone for this high-risk patient group.
Main Methods:
- A prospective single-center cohort study of 100 consecutive patients treated with Wingspan stenting between 2007 and 2009.
- Patients had symptomatic intracranial atherosclerotic stenosis ≥70% and were followed for a primary endpoint of stroke or death within 30 days, followed by ipsilateral ischemic stroke.
- One-year event risk was compared to historical data from the WASID trial.
Main Results:
- Stent placement success rate was 99% with a mean follow-up of 1.8 years.
- The 1-year risk of the primary endpoint events was 7.3% (95% CI, 2.0% to 12.5%) in the Wingspan cohort.
- This risk was significantly lower than the 18% (95% CI, 13% to 24%) observed in historical WASID patients (P<0.05).
Conclusions:
- Wingspan stenting for high-risk intracranial atherosclerotic stenosis in a high-volume center appears to yield favorable clinical outcomes compared to antithrombotic therapy alone.
- A randomized trial is warranted to definitively confirm the benefits of Wingspan stenting combined with medical therapy versus medical therapy alone in high-volume centers.
Background And Purpose:
There were limited data on the long-term outcome of patients with symptomatic intracranial atherosclerotic stenosis ≥70% after Wingspan stenting. Using our Wingspan cohort data and the data from the Warfarin and Aspirin for Symptomatic Intracranial Atherosclerotic Disease (WASID) as a historical control, we tested the hypothesis that stenting provided no benefit over antithrombotic therapy alone for these high-risk patients.
Methods:
Between January 2007 and February 2009, 100 consecutive patients with intracranial atherosclerotic stenosis ≥70% and symptoms within 90 days were enrolled into this prospective single-center Wingspan cohort study and followed up until the end of February 2010. Stenosis was measured per the WASID criteria. One-year risk of primary end point (any stroke or death within 30 days and ipsilateral ischemic stroke afterward) was compared with that of ipsilateral ischemic stroke in the WASID patients with ≥70% stenosis.
Results:
The stent placement success rate was 99%. All patients but 1 had clinical follow-up of ≥12 months. During a mean follow-up of 1.8 years, 9 patients developed primary end point events (5 within 30 days and 4 afterward). The 1-year risk of the outcome events was lower than that in similar WASID patients: 7.3% (95% CI, 2.0% to 12.5%) versus 18% (95% CI, 13% to 24%; P<0.05).
Conclusions:
The clinical outcome of Wingspan stenting for high-risk intracranial atherosclerotic stenosis patients in this high-volume center study compares favorably with that of antithrombotic therapy alone. A randomized trial comparing medical therapy alone with medical therapy plus Wingspan stenting, conducted at high-volume centers, is needed to confirm the stenting benefit.