Safety and efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent

Objective: To assess the safety and efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent. Methods: The medical records of Wingspan stenting for 102 cases with symptomatic middle cerebral artery high-grade stenosis from February 2008 to May 2012 in our hospital were reviewed retrospectively. All of the patients suffered from ischemic stroke or transient ischemic attack (TIA) attributed to the atherosclerotic high-grade stenosis in middle cerebral artery and the stenosis of 70% to 99% was confirmed by DSA before the stenting procedure. All the stroke, death, TIA within 30 days after the stenting procedure or during the follow-up beyond 30 days were observed and recorded. In-stent restenosis were recorded after DSA or CTA was performed 6 months later. test or Fisher exact test was used to compare in-stent restenosis rate among patients with different clinical and pathological conditions. Results: Stenting procedure were successfully performed in 100 patients (98.0%, 100/102). The mean degree of stenosis was reduced from (81.0 ± 8.4)% to (15.3 ± 6.7)% right after surgery. Eight adverse cardiovascular events (7.8%, 8/102) occurred within 30 days, including seven stroke or death (6.9%, 7/102) and 1 TIA. The mean clinical follow-up duration was (29 ± 15) months in 82 patients, and 9 ischemic events were documented (4 cases of ipsilateral recurrent stroke, 3 cases of ipsilateral TIA, and 2 cases of contralateral ischemic stroke). The mean radiological follow-up duration was (11 ± 9) months in 55 patients. Among them, 8 patients (14.3%) had in-stent restenosis and 3 patients had symptomatic restenosis. The restenosis rate in patients with age ≤ 49 years. (25.0%, 7/28) was higher than those with age > 49 years (3.7%, 1/27) (P > 0.05). The restenosis rate in patients with lesion size > 7.5 mm (25.0%, 7/28) was higher than those with lesion size ≤ 7.5 mm (3.7%, 1/27)(P > 0.05). Conclusions: The treatment of symptomatic middle cerebral artery high-grade stenosis with Wingspan system was relatively safe and associated with a low perioperative complication rate. The long-term efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent is prominent. (authors)