title: Influence of patient age and stenosis location on wingspan in-stent restenosis.
abstract: 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.
authors.affiliation: Departments of Radiology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Turk
authors.forename: E I
authors.initials: EI
authors.lastname: Levy
authors.forename: F C
authors.initials: FC
authors.lastname: Albuquerque
authors.forename: G L
authors.initials: GL
authors.lastname: Pride
authors.forename: H
authors.initials: H
authors.lastname: Woo
authors.forename: B G
authors.initials: BG
authors.lastname: Welch
authors.forename: D B
authors.initials: DB
authors.lastname: Niemann
authors.forename: P D
authors.initials: PD
authors.lastname: Purdy
authors.forename: B
authors.initials: B
authors.lastname: Aagaard-Kienitz
authors.forename: P A
authors.initials: PA
authors.lastname: Rasmussen
authors.forename: L N
authors.initials: LN
authors.lastname: Hopkins
authors.forename: T J
authors.initials: TJ
authors.lastname: Masaryk
authors.forename: C G
authors.initials: CG
authors.lastname: McDougall
authors.forename: D
authors.initials: D
authors.lastname: Fiorella
mesh_terms: 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