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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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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

View larger version (62K): [in this window] [in a new window]   Fig 1. A 51-year-old woman initially presented with a right middle cerebral artery distribution stroke. A, Pretreatment angiography demonstrated an irregular stenosis of the supraclinoid segment of the ICA. B, The patient underwent successful PTAS with Wingspan. C, Routine follow-up angiography at 3 months demonstrated long-segment ISR, which was successfully treated with angioplasty.

View larger version (112K): [in this window] [in a new window]   Fig 2. A 55-year-old woman, who initially presented with right-hemisphere watershed infarcts while taking aspirin, had additional transient ischemic attacks while taking aspirin, clopidogrel, and heparin during hospitalization. A, Initial imaging evaluation demonstrated a high-grade right supraclinoid ICA stenosis that was successfully treated with Wingspan PTAS (arrows depict the stent end markers). B, The patient returned with a history of falls and episodic left-handed and arm numbness and weakness 3.5 months after treatment. MR with diffusion imaging demonstrated several small right-hemisphere infarctions. C, Angiography demonstrated long-segment high-grade in-stent restenosis (right anterior oblique [left] and lateral [right] subtracted images). D, Corresponding right anterior oblique (left) and lateral (right) native images. This lesion was successfully retreated with angioplasty.