Influence of patient age and stenosis location on wingspan in-stent restenosis.
OBJECTIVE
Wingspan is a self-expanding, microcatheter-delivered microstent specifically designed for the treatment of symptomatic intracranial atherosclerotic disease. Our aim was to discuss the effect of patient age and lesion location on in-stent restenosis (ISR) rates after percutaneous transluminal angioplasty and stenting (PTAS) with the Wingspan system.


METHODS
Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions. ISR was defined as >50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent and >20% absolute luminal loss. For the present analysis, patients were stratified into younger (</=55 years) and older (>55 years) age groups.


RESULTS
ISR occurred at a rate of 45.2% (14/31) in the younger group and 24.2% (15/62) in the older group (odds ratio, 2.6; 95% confidence interval, 1.03-6.5). In the younger group, ISR occurred after treatment of 13/26 (50%) anterior circulation lesions versus only 1/5 (20%) posterior circulation lesions. In the older group, ISR occurred in 9/29 (31.0%) anterior circulation lesions and 6/33 (18.2%) posterior circulation lesions. In young patients, internal carotid artery lesions (10/17 treated, 58.8%), especially those involving the supraclinoid segment (8/9, 88.9%), were very prone to ISR. When patients of all ages were considered, supraclinoid segment lesions had much higher rates of both ISR (66.6% versus 24.4%) and symptomatic ISR (40% versus 3.9%) in comparison with all other locations.


CONCLUSIONS
Post-Wingspan ISR is more common in younger patients. This increased risk can be accounted for by a high prevalence of anterior circulation lesions in this population, specifically those affecting the supraclinoid segment, which are much more prone to ISR and symptomatic ISR than all other lesions.
Turk
A S
AS
Departments of Radiology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
Levy
E I
EI
Albuquerque
F C
FC
Pride
G L
GL
Woo
H
H
Welch
B G
BG
Niemann
D B
DB
Purdy
P D
PD
Aagaard-Kienitz
B
B
Rasmussen
P A
PA
Hopkins
L N
LN
Masaryk
T J
TJ
McDougall
C G
CG
Fiorella
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000706:statistics & numerical data; D001807:Blood Vessel Prosthesis; D015897:Comorbidity; D003251:Constriction, Pathologic / Q000453:epidemiology; D019544:Equipment Failure Analysis; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology