Stenting for the treatment of high-grade intracranial stenoses.
To date, evidence to recommend endovascular treatment in patients with intracranial stenoses is lacking. Recently, the introduction of self-expanding stents (Wingspan Stent System) aroused considerable expectations in their employ for stroke prevention. We report a single-center experience of percutaneous transluminal angioplasty and stenting in a series of consecutive patients with intracranial stenoses and compare the safety and performance of balloon-mounted stents versus self-expanding stent systems (Wingspan). Thirty-four patients with 39 severe (>70%) intracranial stenoses were treated during a 6-year period. An independent stroke neurologist collected data about intra and periprocedural complications and short-term outcome. We considered as endpoint measures (1) any 30-day stroke or death (2) any major 30-day complication and (3) procedure technical success. Technical success was achieved in all patients. No vessel dissection or ruptures were observed. The 30-day stroke/death rate was 17.9%. Five ischemic strokes in the territory of treated vessels and two intracranial hemorrhages occurred respectively within 24 h and 5 days after endovascular treatment. Three (17.6%) patients of Wingspan treated group and four (18.2%) of the patients treated with different stent systems had unfavorable outcome. Our study confirms that endovascular treatment can be performed with a high technical success rate, even though the safety of these devices has still to be demonstrated.
Lanfranconi
S
S
Centro Dino Ferrari, Università degli Studi di Milano, Milan, Italy.
Bersano
A
A
Branca
V
V
Ballabio
E
E
Isalberti
M
M
Papa
R
R
Candelise
L
L
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods