title: Outcomes of middle cerebral artery angioplasty and stenting with Wingspan at a high-volume center.
abstract: BACKGROUND
  This study was to investigate the periprocedural stroke rates, safety, and long-term effect of Wingspan stenting for symptomatic severe stenosis of the middle cerebral artery (MCA) at a high-volume center.
  
  
  METHODS
  Between July 2007 and April 2013, 196 consecutive patients with severe MCA atherosclerotic stenosis (≥70%) who were treated with Wingspan stenting were retrospectively studied. All patients had arterial stenosis-related temporary ischemic attack or strokes. The demographic data, cerebral angiography, technical success rate, periprocedural complications, and clinical and imaging follow-up were analyzed.
  
  
  RESULTS
  The successful stenting rate was 98.0%, and the stenosis rate was improved from pre-stenting (80.6 ± 8.3 %) to post-stenting (15.5 ± 6.8%). The 30-day periprocedural stroke or death rate was 7.1%, with a disabling or fatal rate of 2.6%. The perioprocedural stroke rate was significantly (P < 0.01) greater in the early learning stage (16.0%) than in the later technical maturation stage (4.1%). The total periprocedural ischemic and perforator stroke rates were greater in patients with the most stenosis in the distal MCA 1/3 segment (6.8 and 5.7%, respectively) than in the proximal and middle 2/3 segments (0.9 and 0%, respectively). The ipsilateral stroke or death rate beyond 30 days (6-69 months, mean 30 ± 16) was 4.8%, with the 1- and 2-year cumulative stroke rates of 9.6 and 12.1%, respectively. Imaging follow-up 6-69 months (mean 10.9 ± 8.5) revealed restenosis in 21 cases (20.4 %).
  
  
  CONCLUSIONS
  Intracranial stenting of MCA stenoses may have the potential of better clinical outcomes if patients are properly selected and treated by an experienced operator at a high-volume center.
authors.affiliation: Stroke Center, Zhengzhou University Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan Province, 450003, People's Republic of China.
authors.forename: Zi-Liang
authors.initials: ZL
authors.lastname: Wang
authors.affiliation: Department of Medical Research, Shijiazhuang First Hospital, Hebei Medical University, Hebei, People's Republic of China.
authors.forename: Bu-Lang
authors.initials: BL
authors.lastname: Gao
authors.affiliation: Stroke Center, Zhengzhou University Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan Province, 450003, People's Republic of China. litianxiaod@163.com.
authors.forename: Tian-Xiao
authors.initials: TX
authors.lastname: Li
authors.affiliation: Stroke Center, Zhengzhou University Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan Province, 450003, People's Republic of China.
authors.forename: Dong-Yang
authors.initials: DY
authors.lastname: Cai
authors.affiliation: Stroke Center, Zhengzhou University Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan Province, 450003, People's Republic of China.
authors.forename: Liang-Fu
authors.initials: LF
authors.lastname: Zhu
authors.affiliation: Stroke Center, Zhengzhou University Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan Province, 450003, People's Republic of China.
authors.forename: Jiang-Yu
authors.initials: JY
authors.lastname: Xue
authors.affiliation: Stroke Center, Zhengzhou University Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan Province, 450003, People's Republic of China.
authors.forename: Wei-Xing
authors.initials: WX
authors.lastname: Bai
authors.affiliation: Stroke Center, Zhengzhou University Henan Provincial People's Hospital, Zhengzhou University, 7 Weiwu Road, Zhengzhou, Henan Province, 450003, People's Republic of China.
authors.forename: Zhao-Shuo
authors.initials: ZS
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000295:instrumentation; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D002533:Cerebral Angiography / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D019544:Equipment Failure Analysis; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Intracranial atherosclerotic stenosis; Long term; Middle cerebral artery; Periprocedural stroke; Wingspan stenting