P-006 Angioplasty and secondary stenting for symptomatic intracranial stenosis

Introduction Angioplasty alone and primary stent placement have both been proposed as treatment options for symptomatic intracranial stenosis. Since the Wingspan stent has been approved for use, our centers have adopted a treatment plan of performing primary angioplasty and using the Wingspan stent if the angioplasty result is considered suboptimal or if the patient develops recurrent stenosis after angioplasty. This report analyzes our results for the two groups of patients, those with angioplasty alone and those with secondary stenting. Materials and methods All patients treated at two institutions from 2006 through 2009 with angioplasty (PTA) or angioplasty followed by stent placement for symptomatic intracranial stenosis were included in this study. 45 patients (age 63+12 years, 31 men, 14 women) underwent a total of 50 endovascular procedures. Lesions were located in the internal carotid artery (n=12), middle cerebral artery (MCA) (n=10) and vertebrobasilar (23). 33 patients were treated with primary angioplasty. Twelve patients received stents on the first procedure day when the angioplasty was judged suboptimal due to recoil or dissection being present. In addition, five patients were stented when they subsequently developed restenosis. Periprocedural (30 day) complications, postprocedure strokes and restenosis were calculated for two groups; patients receiving angioplasty alone on the first procedure day and patients receiving stents on the first procedure day. The five patients receiving stents subsequent to the primary angioplasty were included in an intention to treat analysis with the angioplasty group. Results All lesions in both groups were successfully dilated. In the PTA group, mean stenosis went from 82.7% pretreatment (range 70–95) to 42.7% post (range 15–85). In the stent group, mean stenosis went from 84.0% (range 70–95) to 33.6% post (20–70). In the PTA group there were two (6.1%) periprocedural (30 day) strokes, both lenticulostriate strokes, at the procedure. In the stent group there were three (25%) periprocedural strokes. Two occurred at the procedure. One was thought to be due a vessel rupture from wire perforation and one due to emboli. One occurred within 30 days due to thrombus development within the stent. Restenosis occurred in five (15.2%) of the PTA patients. Two of these were in the anterior circulation and three in the posterior. All of these were subsequently stented. Restenosis occurred in four (33.3%) of the stented patients. All of these were in the anterior circulation. In the PTA group there was one stroke (3.0%) in the territory of treatment after 30 days. This patient had a left MCA stenosis that restenosed 8 months after angioplasty, underwent stenting and had a stroke following the stenting procedure with occlusion of the artery. In the stenting group there was one stroke (8.3%). The patient had a right MCA stent placed and had a stroke 4 months later with vessel occlusion. Conclusion Stenting with the Wingspan stent can be used to treat patients with suboptimal angioplasty results. However, the periprocedural stroke, restenosis and subsequent stroke rates appear to be higher in this stented group.