A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses - The Wingspan study

Background and Purpose - The purpose of this study was to assess the safety and performance of the Wingspan stent system and Gateway percutaneous transluminal angioplasty balloon catheter in the treatment of high-grade, intracranial atherosclerotic lesions in patients who had failed medical therapy. Methods - In this prospective, multicenter, single-arm study, medically refractory patients with a modified Rankin score <= 3 and recurrent symptoms attributable to angiographically demonstrated intracranial stenosis >= 50% in a vessel 2.5 to 4.5 mm in diameter were enrolled. Intracranial lesions were predilated with an undersized Gateway balloon catheter to 80% of the native vessel diameter, followed by deployment of the self-expanding Wingspan stent to facilitate further remodeling of the atherosclerotic plaque and to maintain vessel patency. Neurologic examinations and angiograms were performed at 6 months after the procedure. Results - Among the 45 patients enrolled, the degree of stenosis was reduced from a baseline of 74.9 +/- 9.8% to 31.9 +/- 13.6% after stenting and 28 +/- 23.2% at the 6-month follow-up. The 30-day composite ipsilateral stroke/death rate was 4.5% ( 2/44); at the 6-month follow-up, the ipsilateral stroke/death rate was 7.0%, the rate for all strokes was 9.7%, and all-cause mortality was 2.3%. Physician-reported follow-up in 43 patients ( average of 13 months) conducted outside the study protocol ( not adjudicated by the clinical event committee) reported 1 additional ipsilateral stroke. Conclusions - In medically refractory patients with high-grade intracranial atherosclerotic stenoses, a new treatment paradigm involving predilation with an undersized Gateway percutaneous transluminal angioplasty balloon catheter and placement of a self-expanding Wingspan stent system appears to be safe, may facilitate remodeling, and may contribute to favorable angiographic outcomes.