TY - JOUR
T1 - Target lesion revascularization after wingspan
T2 - Assessment of safety and durability
AU - Fiorella, David J.
AU - Levy, Elad I.
AU - Turk, Aquilla S.
AU - Albuquerque, Felipe C.
AU - Pride, G. Lee
AU - Woo, Henry H.
AU - Welch, Babu G.
AU - Niemann, David B.
AU - Purdy, Phillip D.
AU - Aagaard-Kienitz, Beverly
AU - Rasmussen, Peter A.
AU - Hopkins, L. Nelson
AU - Masaryk, Thomas J.
AU - McDougall, Cameron G.
PY - 2009/1/1
Y1 - 2009/1/1
N2 - BACKGROUND AND PURPOSE: In-stent restenosis (ISR) occurs in approximately one-third of patients after the percutaneous transluminal angioplasty and stenting of intracranial atherosclerotic lesions with the Wingspan system. We review our experience with target lesion revascularization (TLR) for ISR after Wingspan treatment. METHODS: Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions in our US Wingspan Registry. ISR was defined as >50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent and >20% absolute luminal loss. RESULTS: To date, 36 patients in the registry have experienced ISR after percutaneous transluminal angioplasty and stenting with Wingspan. Of these patients, 29 (80.6%) have undergone TLR with either angioplasty alone (n≤26) or angioplasty with restenting (n≤3). Restenting was performed for in-stent dissections that occurred after the initial angioplasty. Of the 29 patients undergoing TLR, 9 required ĝ‰¥1 interventions for recurrent ISR, for a total of 42 interventions. One major complication, a postprocedural reperfusion hemorrhage, was encountered in the periprocedural period (2.4% per procedure; 3.5% per patient). Angiographic follow-up is available for 22 of 29 patients after TLR. Eleven of 22 (50%) demonstrated recurrent ISR at follow-up angiography. Nine patients have undergone multiple retreatments (2 retreatments, n≤6; 3 retreatments, n≤2; 4 retreatments, n≤1) for recurrent ISR. Nine of 11 recurrent ISR lesions were located within the anterior circulation. The mean age for patients with recurrent anterior circulation ISR was 57.9 years (vs 81 years for posterior circulation ISR). CONCLUSIONS: TLR can be performed for the treatment of intracranial Wingspan ISR with a relatively high degree of safety. However, the TLR results are not durable in ĝ‰̂50% of patients, and multiple revascularization procedures may be required in this subgroup.
AB - BACKGROUND AND PURPOSE: In-stent restenosis (ISR) occurs in approximately one-third of patients after the percutaneous transluminal angioplasty and stenting of intracranial atherosclerotic lesions with the Wingspan system. We review our experience with target lesion revascularization (TLR) for ISR after Wingspan treatment. METHODS: Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions in our US Wingspan Registry. ISR was defined as >50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent and >20% absolute luminal loss. RESULTS: To date, 36 patients in the registry have experienced ISR after percutaneous transluminal angioplasty and stenting with Wingspan. Of these patients, 29 (80.6%) have undergone TLR with either angioplasty alone (n≤26) or angioplasty with restenting (n≤3). Restenting was performed for in-stent dissections that occurred after the initial angioplasty. Of the 29 patients undergoing TLR, 9 required ĝ‰¥1 interventions for recurrent ISR, for a total of 42 interventions. One major complication, a postprocedural reperfusion hemorrhage, was encountered in the periprocedural period (2.4% per procedure; 3.5% per patient). Angiographic follow-up is available for 22 of 29 patients after TLR. Eleven of 22 (50%) demonstrated recurrent ISR at follow-up angiography. Nine patients have undergone multiple retreatments (2 retreatments, n≤6; 3 retreatments, n≤2; 4 retreatments, n≤1) for recurrent ISR. Nine of 11 recurrent ISR lesions were located within the anterior circulation. The mean age for patients with recurrent anterior circulation ISR was 57.9 years (vs 81 years for posterior circulation ISR). CONCLUSIONS: TLR can be performed for the treatment of intracranial Wingspan ISR with a relatively high degree of safety. However, the TLR results are not durable in ĝ‰̂50% of patients, and multiple revascularization procedures may be required in this subgroup.
KW - Intracranial atherosclerotic disease
KW - Poststenting in-stent restenosis
KW - Target lesion revascularization
KW - Wingspan stent system
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U2 - 10.1161/STROKEAHA.108.525774
DO - 10.1161/STROKEAHA.108.525774
M3 - Article
C2 - 18927447
AN - SCOPUS:60549112007
SN - 0039-2499
VL - 40
SP - 106
EP - 110
JO - Stroke
JF - Stroke
IS - 1
ER -