title: Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management.
abstract: OBJECTIVE
  Wingspan (Boston Scientific, Fremont, CA) is a self-expanding stent designed specifically for the treatment of symptomatic intracranial atheromatous disease. The current series reports the observed incidence of in-stent restenosis (ISR) and thrombosis on angiographic follow-up.
  
  
  METHODS
  A prospective, intent-to-treat registry of patients in whom the Wingspan stent system was used to treat symptomatic intracranial atheromatous disease was maintained at five participating institutions. Clinical and angiographic follow-up results were recorded. ISR was defined as stenosis greater than 50% within or immediately adjacent (within 5 mm) to the implanted stents and absolute luminal loss greater than 20%.
  
  
  RESULTS
  To date, follow-up imaging (average duration, 5.9 mo; range, 1.5-15.5 mo) is available for 84 lesions treated with the Wingspan stent (78 patients). Follow-up examinations consisted of 65 conventional angiograms, 17 computed tomographic angiograms, and two magnetic resonance angiograms. Of these lesions with follow-up, ISR was documented in 25 and complete thrombosis in four. Two of the 4 patients with stent thrombosis had lengthy lesions requiring more than one stent to bridge the diseased segment. ISR was more frequent (odds ratio, 4.7; 95% confidence intervals, 1.4-15.5) within the anterior circulation (42%) than the posterior circulation (13%). Of the 29 patients with ISR or thrombosis, eight were symptomatic (four with stroke, four with transient ischemic attack) and 15 were retreated. Of the retreatments, four were complicated by clinically silent in-stent dissections, two of which required the placement of a second stent. One was complicated by a postprocedural reperfusion hemorrhage.
  
  
  CONCLUSIONS
  The ISR rate with the Wingspan stent is higher in our series than previously reported, occurring in 29.7% of patients. ISR was more frequent within the anterior circulation than the posterior circulation. Although typically asymptomatic (76% of patients in our series), ISR can cause neurological symptoms and may require target vessel revascularization.
authors: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York, USA.
authors: Elad I
authors: EI
authors: Levy
authors: Aquilla S
authors: AS
authors: Turk
authors: Felipe C
authors: FC
authors: Albuquerque
authors: David B
authors: DB
authors: Niemann
authors: Beverly
authors: B
authors: Aagaard-Kienitz
authors: Lee
authors: L
authors: Pride
authors: Phil
authors: P
authors: Purdy
authors: Babu
authors: B
authors: Welch
authors: Henry
authors: H
authors: Woo
authors: Peter A
authors: PA
authors: Rasmussen
authors: L Nelson
authors: LN
authors: Hopkins
authors: Thomas J
authors: TJ
authors: Masaryk
authors: Cameron G
authors: CG
authors: McDougall
authors: David J
authors: DJ
authors: Fiorella
mesh_terms: D023903:Coronary Restenosis / Q000453:epidemiology* / Q000628:therapy*; D019468:Disease Management; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012042:Registries; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000453:epidemiology* / Q000628:therapy*