MRI audit of complications in intracranial stenosis treated with Wingspan device
Leonard L L Yeo1, Y M Wu2,3, Y L Chen3,4
1Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.
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.
Insights
Wingspan stenting is safe and effective for symptomatic intracranial atherosclerotic stenosis (ICAS), showing high success rates and good patient outcomes. Asymptomatic microembolic events on MRI were common but did not lead to long-term issues.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Symptomatic intracranial atherosclerotic stenosis (ICAS) poses a significant risk of stroke.
- Endovascular treatment, including stenting, is an option for managing ICAS.
- The Wingspan stent system is used for treating intracranial stenosis.
Purpose of the Study:
- To evaluate the safety and efficacy of the Wingspan device for treating symptomatic ICAS.
- To assess periprocedural complications and functional outcomes after Wingspan stenting.
Main Methods:
- Prospective audit of a consecutive patient database undergoing Wingspan stenting (January 2013 - December 2015).
- Early follow-up MRI to detect complications; assessment of clinical demographics and lesion characteristics.
- Functional outcomes measured using the modified Rankin Scale (mRS) at discharge and 3 months.
Main Results:
- Successful stenting in 50 patients with significant reduction in stenosis (76.5% to 19.8%).
- Overall 30-day complication rate was 6.0%; 12% total complications by 1-year follow-up.
- High incidence (46%) of asymptomatic diffusion-weighted imaging (DWI) hyperintensities, presumed microembolic.
- 92% achieved excellent functional outcomes (mRS 0-1).
Conclusions:
- Wingspan stenting with pre-placement balloon angioplasty is safe and effective for symptomatic ICAS.
- High technical success and favorable patient outcomes were observed.
- Asymptomatic DWI hyperintensities post-procedure did not appear to cause long-term sequelae.
