IschemiaIntracranial angioplasty with Gateway-Wingspan system for symptomatic atherosclerotic stenosis: preliminary results of 27 Chinese patients
Introduction
Intracranial atherosclerotic stenosis is a main cause of acute stroke or TIA, and its prevalence differs between races [18]. A higher prevalence in Chinese subjects was reported [5], [9], [22]. The prognosis of patients with serious intracranial atherosclerotic stenosis was poor [4]. A high risk of ischemic events was noted even if patients were taking aspirin and warfarin, and the prevalence increased with stenosis severity [2], [4], [16], [21]. Angioplasty with or without stents is recommended for serious intracranial atherosclerotic stenosis. Several studies have shown that recurrence rates for patients with intracranial atherosclerotic stenosis decreased after angioplasty with a balloon or balloon-mounted stent [10], [11], [15], but these procedures were associated with a high prevalence of complications (eg, vessel injury) [7], [14].
The Gateway-Wingspan system uses a self-expandable stent to treat intracranial stenosis. Initial results indicated that it was safe and effective with an acceptable prevalence of complications and mortality [3], [6], [8]. The present study details the initial experiences and preliminary results after its use in Chinese patients with intracranial stenosis at our institution and after it was introduced in Chinese hospitals in April 2007.
Section snippets
Patients and methods
This was a retrospective review study. Twenty-seven patients (age, 36-71 years; mean, 60.1 years) with intracranial atherosclerotic stenoses received angioplasty with the Wingspan stent system in Tangdu Hospital (Xian, China) from May to October 2007. All subjects had a history of ischemic events before treatment. Fourteen patients presented with TIA including paroxysmal aphasia or hemiplegia, 9 patients presented with acute stroke but recovered well after taking medication, and 4 patients had
Results
Twenty-nine lesions in 27 patients were revascularized with 29 Gateway-Wingspan stent systems. Sixteen stenoses of the vertebra basilar artery in 15 patients were treated with 16 Wingspan stents; 9 stenoses of the middle cerebral artery in 9 patients were treated with nine Wingspan stents; and stenoses of the middle cerebral artery and basilar artery in 1 patient were treated with two Wingspan stents. The Gateway balloons crossed stenoses smoothly in all patients and there was no dissection
Discussion
Cerebrovascular disease is one of the main causes of death worldwide. In the United States, about 700 000 patients are diagnosed with ischemic stroke every year [1], whereas up to 1.5 million are diagnosed with the same condition in China [19]. For whites, about 8% to 10% of cases of acute infarction are caused by intracranial atherosclerotic stenosis [18]. The prevalence is as high as 33% in Chinese subjects [22]. The cause was intracranial stenosis in nearly 50% of Chinese patients presenting
Conclusion
Angioplasty with a Wingspan system to treat symptomatic intracranial atherosclerotic stenoses appears to be safe, with acceptable morbidity and mortality. Its initial effect on prevention of ischemic events is acceptable, and the long-term effect needs investigation. Preliminary results in a small patient population did not show obvious superiority of the Wingspan stent compared with a balloon-mounted stent.
References (22)
Guidelines for medical treatment for stroke prevention
Ann Intern Med
(1994)- et al.
Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study
Stroke
(2001) - et al.
A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study
Stroke
(2007) - et al.
Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis
N Engl J Med.
(2005) - et al.
Chinese-white differences in the distribution of occlusive cerebrovascular disease
Neurology
(1990) - et al.
US multicenter experience with the Wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results
Stroke
(2007) - et al.
Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis
Neurology
(2003) - et al.
Treatment of intracranial atherosclerotic stenoses with balloon dilatation and self-expanding stent deployment (WingSpan)
Neuroradiology
(2005) - et al.
Vascular lesions in Chinese patients with transient ischemic attacks
Neurology
(1997) - et al.
Stenting of symptomatic M1 stenosis of middle cerebral artery: an initial experience of 40 patients
Stroke
(2004)
Elective stenting for symptomatic middle cerebral artery stenosis presenting as transient ischaemic deficits or stroke attacks: short term arteriographical and clinical outcome
J Neurol Neurosurg Psychiatry
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