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Wingspan stenting can effectively prevent long-term strokes for patients with severe symptomatic atherosclerotic
Wei-Xing Bai1, Bu-Lang Gao2, Tian-Xiao Li3
1Stroke Center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China.
Insights
Wingspan stenting effectively reduced severe basilar artery stenosis. While the peri-operative stroke rate was 14.3%, long-term benefits include a lower risk of fatal and disabling strokes for patients with severe stenosis.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Severe symptomatic atherosclerotic basilar artery stenosis poses a significant risk of stroke.
- Endovascular treatment options are being explored to manage this condition.
Purpose of the Study:
- To evaluate the safety and long-term efficacy of Wingspan stenting for severe (≥70%) atherosclerotic basilar artery stenosis.
- To assess the peri-procedural complications and clinical outcomes following the procedure.
Main Methods:
- A cohort of 91 consecutive patients with severe symptomatic basilar stenosis underwent Wingspan stenting between 2007 and 2013.
- Data analyzed included demographics, pre- and post-procedural angiography, technical success, complications, and clinical/imaging follow-ups.
Main Results:
- Wingspan stenting achieved technical success in all patients, reducing stenosis from 82.2% to 15.9%.
- The 30-day peri-operative stroke or death rate was 14.3% (13.2% ischemic stroke, 1.1% subarachnoid hemorrhage), with a 2.2% fatal/disabling stroke rate.
- At long-term follow-up (mean 31.3 months), the 2-year cumulative stroke rate was 16%, and restenosis occurred in 13.0% of patients (4.3% symptomatic).
Conclusions:
- Wingspan stenting may reduce long-term fatal and disabling stroke rates in patients with severe basilar artery stenosis.
- The procedure is beneficial if the peri-operative stroke rate is maintained at a lower level.
Objective:
To investigate the safety and long-term effect of using the Wingspan stent for severe symptomatic atherosclerotic basilar artery stenosis (≥70%).
Materials And Methods:
Between July 2007 and April 2013, we had 91 consecutive patients (age range 41-82 years old) with symptomatic severe basilar stenosis (70-99%) who underwent Wingspan stenting at our center. All patients had stenosis-related temporary ischemic attack or strokes. We analyzed the demographic data, pre- and post-procedural cerebral angiography, technical success rate, peri-procedural complications, and clinical and imaging follow-ups.
Results:
The Wingspan stenting procedure was successful in all patients: The stenosis was reduced from 82.2% ± 5.8% pre-stenting to 15.9% ± 5.7% post-stenting. The 30-day peri-operative rate for stroke or death was 14.3%, which included ischemic stroke in 12 cases (12/91 = 13.2%) and subarachnoid hemorrhage in one case (1/91 = 1.1%), with a fatal or disabling stroke rate of 2.2%. Among the 77 patients with clinical follow-up assessment within 7-60 months (mean 31.3 ± 15.1 months) after stenting, four patients (5.2%) had posterior ischemia, including one patient with disabling ischemic stroke (1.3%) and three patients (3.9%) with temporary ischemic attack. The 2-year cumulative stroke rate was 16% (95% CI: 8.2-23.8%). Among 46 patients with imaging assessments at 3-45 months (mean, 9.5 ± 8.3) post-stenting, six (13.0%) patients had restenosis, including two (2/46 = 4.3%) with symptomatic restenosis.
Conclusions:
The benefit of stenting for patients with severe basilar artery stenosis (> 70%) may lie in lowering the long-term fatal and disabling stroke rate; and as long as the peri-operative stroke rate can be kept at a relatively lower level, patients with severe basilar stenosis can benefit from basilar artery stenting.
