Angioplasty and Stenting of Atherosclerotic Middle Cerebral Arteries with Wingspan: Evaluation of Clinical Outcome, Restenosis, and Procedure Outcome

BACKGROUND AND PURPOSE: MCA is a common location of intracranial stenosis. It is relatively more peripherally located and of a smaller caliber, and could therefore be a site technically more challenging and risky for angioplasty and stenting. The study aimed to evaluate the clinical outcome, restenosis rate, and procedural safety of Wingspan stent placement for atherosclerosis in the MCA compared with stenosis in other arteries.

MATERIALS AND METHODS: Patients who underwent Wingspan stent placement for symptomatic intracranial stenosis of ≥70% (or stenosis of ≥50% for recurrent ischemia despite medical therapy) were recruited prospectively and allocated into a study group (MCA stenosis, n = 35) and a control group (other stenosis, n = 25). Primary end points were the following: 1) all stroke or death rate at 1 year, and 2) significant in-stent restenosis rate at 1 year. Secondary end points were the following: 1) periprocedural complications within 24 hours, rate of TIA during the procedure, all stroke or death rate within 30 days; and 2) the inability to complete the procedure due to technical problems.

RESULTS: Results of study group versus the control group were the following: degree of stenosis, 78.4 ± 10.9% versus 72.5 ± 11.2% (P value = .0456); diameter of stenosis, 0.6 ± 0.3 versus 1.0 ± 0.5 mm (P = .0017); all stroke or death rate at 1 year, 14.3% versus 12% (OR = 1.22); in-stent restenosis rate at 1 year, 10% versus 10.5% (OR = 1.05); periprocedural complication rate at 24 hours, 2.9% versus 4% (OR = 0.70); TIA rate during the procedure, 8.6% versus 4% (OR = 2.25); all stroke or death rate at 30 days, 5.7% versus 12% (OR = 0.44); and technical failure rate, 2.9% versus 0%.

CONCLUSIONS: In this study, there were no significant differences in procedural safety, patient outcome, and restenosis rates of stent placement between the group with MCA stenosis and the group with stenoses located at other sites.