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AJNR - American Journal of Neuroradiology

Published ahead of print on November 7, 2007
doi: 10.3174/ajnr.A0869

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American Journal of Neuroradiology 29:23-27, January 2008
© 2008 American Society of Neuroradiology

EXPEDITED PUBLICATION

Influence of Patient Age and Stenosis Location on Wingspan In-Stent Restenosis

A.S. Turk^a, E.I. Levy^b,c, F.C. Albuquerque^d, G.L. Pride, Jr^e, H. Woo^f, B.G. Welch^e, D.B. Niemann^g, P.D. Purdy^e, B. Aagaard-Kienitz^g, P.A. Rasmussen^h, L.N. Hopkins^b,c, T.J. Masaryk^h, C.G. McDougall^d and D. Fiorella^h

^a Departments of Radiology and Neurosurgery, Medical University of South Carolina, Charleston, SC
^b Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
^c Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, NY
^d Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Ariz
^e Departments of Neurosurgery and Neuroradiology, University of Texas Southwestern, Dallas, Tex
^f Departments of Neurological Surgery and Radiology, University at Stony Brook, State University of New York, Stony Brook, NY
^g Departments of Neurosurgery and Neuroradiology, University of Wisconsin, Madison, Wis
^h Departments of Neurosurgery and Neuroradiology, Cleveland Clinic Foundation, Cleveland, Ohio

Please address correspondence to David J. Fiorella, MD, PhD, Cleveland Clinic, Cleveland, OH 44195; e-mail: fioreld{at}ccf.org

BACKGROUND AND PURPOSE: 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.

MATERIALS AND 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.

CONCLUSION: 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.

This article has been cited by other articles:

				K.F. Layton, J.H. Hise, and I.C. Thacker Recurrent Intracranial Stenosis Induced by the Wingspan Stent: Comparison with Balloon Angioplasty Alone in a Single Patient AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1050 - 1052. [Abstract] [Full Text] [PDF]