CardioVascular and Interventional Radiology

, Volume 34, Issue 1, pp 54–60 | Cite as

Comparison of BMSs with SES for Symptomatic Intracranial Disease of the Middle Cerebral Artery Stenosis

  • Xuanye Yue
  • Qin Yin
  • Gangming Xi
  • Wusheng Zhu
  • Gelin Xu
  • Renliang Zhang
  • Zhiming Zhou
  • Minmin Ma
  • Guangfu Jin
  • Xinfeng Liu
Clinical Investigation

Abstract

This study was designed to compare the clinical and angiographic outcomes of patients with symptomatic atherosclerotic middle cerebral artery stenosis treated with balloon-mounted stents (BMS) and self-expandable Wingspan system (SES). We reviewed the 69 consecutive stent placement procedures for symptomatic atherosclerotic stenosis (≥70) in M1 segment of middle cerebral artery in 67 patients in 3 years. According to the stent types, the patients were classed as BMS and SES groups. The demographic characteristics, conventional risk factors of ischemic stroke, degree of stenosis, periprocedural complications, stent types, and clinical and angiographic outcomes were analyzed. There were 39 patients in the BMS group and 28 patients in the SES group. The demographic characteristics, conventional risk factors, and periprocedural complications were similar but different in residual stenosis after stenting in both groups (5.9% ± 9.9% vs. 14.4% ± 14.6%; P = 0.01). For the overall cohort, the rate of stroke or death and restenosis was 10.9% (7/66) and 24.5% (14/57), respectively. The frequency of restenosis was higher in the SES group than in the BMS group (log-rank, P = 0.04; crude hazard ratio = 3.03; 95% confidence interval (CI), 1.01–9.15; P = 0.049; and adjusted hazard ratio = 3.61; 95% CI, 1.06–12.27; P = 0.04); however, there was no difference in clinical outcomes (log-rank, P = 0.51; crude hazard ratio = 1.66; 95% CI, 0.36–7.61; P = 0.51; and adjusted hazard ratio = 0.59; 95% CI, 0.04–7.89; P = 0.69). The corrected degree of restenosis was higher in the SES than the BMS group. The prevalence of restenosis was higher in the SES than the BMS group, but the perioperative complications and follow-up clinical outcomes had no significant difference.

Keywords

Balloon-mounted stent Middle cerebral artery Restenosis Stenosis Stroke Wingspan 

Notes

Conflicts of Interest Statement

Drs. X. Yue, Q. Yin, G. Xu, R. Zhang, Z. Zhou, M. Ma, and X. Liu have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Wong KS, Huang YN, Gao S et al (1998) Intracranial stenosis in Chinese patients with acute stroke. Neurology 50:812–813PubMedGoogle Scholar
  2. 2.
    Chimowitz MI, Lynn MJ, Howlett-Smith H et al (2005) Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352:1305–1316CrossRefPubMedGoogle Scholar
  3. 3.
    Arenillas JF, Molina CA, Montaner J et al (2001) Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study. Stroke 32:2898–2904CrossRefPubMedGoogle Scholar
  4. 4.
    Thijs VN, Albers GW (2000) Symptomatic intracranial atherosclerosis: outcome of patients who fail antithrombotic therapy. Neurology 55:490–497PubMedGoogle Scholar
  5. 5.
    The EC/IC Bypass Study Group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313:1191–1200CrossRefGoogle Scholar
  6. 6.
    Komotar RJ, Starke RM, Otten ML et al (2009) The role of indirect extracranial-intracranial bypass in the treatment of symptomatic intracranial atheroocclusive disease. J Neurosurg 110:896–904CrossRefPubMedGoogle Scholar
  7. 7.
    Sundt TM Jr, Smith HC, Campbell JK et al (1980) Transluminal angioplasty for basilar artery stenosis. Mayo Clin Proc 55:673–680PubMedGoogle Scholar
  8. 8.
    Mori T, Fukuoka M, Kazita K et al (1998) Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty. AJNR Am J Neuroradiol 19:1525–1533PubMedGoogle Scholar
  9. 9.
    McKenzie JD, Wallace RC, Dean BL et al (1996) Preliminary results of intracranial angioplasty for vascular stenosis caused by atherosclerosis and vasculitis. AJNR Am J Neuroradiol 17:263–268PubMedGoogle Scholar
  10. 10.
    Lee JH, Kwon SU, Suh DC et al (2003) Percutaneous transluminal angioplasty for symptomatic middle cerebral artery stenosis: long-term follow-up. Cerebrovasc Dis 15:90–97CrossRefPubMedGoogle Scholar
  11. 11.
    Kim JT, Lee SH, Choi SM et al (2009) Long-term durability of percutaneous transluminal angioplasty in patients with symptomatic middle cerebral artery stenosis. J Clin Neurol 5:24–28CrossRefPubMedGoogle Scholar
  12. 12.
    Lee TH, Kim DH, Lee BH et al (2005) Preliminary results of endovascular stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. AJNR Am J Neuroradiol 26:166–174PubMedGoogle Scholar
  13. 13.
    Bose A, Hartmann M, Henkes H et al (2007) A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 38:1531–1537CrossRefPubMedGoogle Scholar
  14. 14.
    Fiorella D, Levy EI, Turk AS et al (2007) US multicenter experience with the Wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results. Stroke 38:881–887CrossRefPubMedGoogle Scholar
  15. 15.
    Miao ZR, Feng L, Li S et al (2009) Treatment of symptomatic middle cerebral artery stenosis with balloon-mounted stents: long-term follow-up at a single center. Neurosurgery 64:79–84CrossRefPubMedGoogle Scholar
  16. 16.
    Jiang WJ, Du B, Leung TW et al (2007) Symptomatic intracranial stenosis: cerebrovascular complications from elective stent placement. Radiology 243:188–197CrossRefPubMedGoogle Scholar
  17. 17.
    Jiang WJ, Wang YJ, Du B et al (2004) Stenting of symptomatic M1 stenosis of middle cerebral artery: an initial experience of 40 patients. Stroke 35:1375–1380CrossRefPubMedGoogle Scholar
  18. 18.
    Jiang WJ, Xu XT, Jin M et al (2007) Apollo stent for symptomatic atherosclerotic intracranial stenosis: study results. AJNR Am J Neuroradiol 28:830–834PubMedGoogle Scholar
  19. 19.
    Groschel K, Schnaudigel S, Pilgram SM et al (2009) A systematic review on outcome after stenting for intracranial atherosclerosis. Stroke 40:e340–e347CrossRefPubMedGoogle Scholar
  20. 20.
    Levy EI, Turk AS, Albuquerque FC et al (2007) Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management. Neurosurgery 61:644–650CrossRefPubMedGoogle Scholar
  21. 21.
    Samuels OB, Joseph GJ, Lynn MJ et al (2000) A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 21:643–646PubMedGoogle Scholar
  22. 22.
    Zaidat OO, Klucznik R, Alexander MJ et al (2008) The NIH registry on use of the Wingspan stent for symptomatic 70–99% intracranial arterial stenosis. Neurology 70:1518–1524CrossRefPubMedGoogle Scholar
  23. 23.
    Turk AS, Levy EI, Albuquerque FC et al (2008) Influence of patient age and stenosis location on Wingspan in-stent restenosis. AJNR Am J Neuroradiol 29:23–27CrossRefPubMedGoogle Scholar
  24. 24.
    Singh M, Gersh BJ, McClelland RL et al (2004) Clinical and angiographic predictors of restenosis after percutaneous coronary intervention: insights from the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) trial. Circulation 109:2727–2731CrossRefPubMedGoogle Scholar
  25. 25.
    Presbitero P, Carcagni A (2003) Gender differences in the outcome of interventional cardiac procedures. Ital Heart J 4:522–527PubMedGoogle Scholar
  26. 26.
    Sick P, Huttl T, Niebauer J et al (2003) Influence of residual stenosis after percutaneous coronary intervention with stent implantation on development of restenosis and stent thrombosis. Am J Cardiol 91:148–153CrossRefPubMedGoogle Scholar
  27. 27.
    Albuquerque FC, Levy EI, Turk AS et al (2008) Angiographic patterns of Wingspan in-stent restenosis. Neurosurgery 63:23–27CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Xuanye Yue
    • 1
    • 2
  • Qin Yin
    • 1
  • Gangming Xi
    • 2
  • Wusheng Zhu
    • 1
  • Gelin Xu
    • 1
  • Renliang Zhang
    • 1
  • Zhiming Zhou
    • 1
  • Minmin Ma
    • 1
  • Guangfu Jin
    • 3
  • Xinfeng Liu
    • 1
  1. 1.Department of Neurology, Jinling HospitalNanjing University School of MedicineNanjingChina
  2. 2.Department of Neurology, Shiyan People HospitalYunyang Medical CollegeShiyanChina
  3. 3.Department of Epidemiology and Biostatistics, School of Public HealthNanjing Medical UniversityNanjingChina

Personalised recommendations