Turk A S, Levy E I, Albuquerque F C, Pride G L, Woo H, Welch B G, Niemann D B, Purdy P D, Aagaard-Kienitz B, Rasmussen P A, Hopkins L N, Masaryk T J, McDougall C G, Fiorella D
Departments of Radiology and Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
AJNR Am J Neuroradiol. 2008 Jan;29(1):23-7. doi: 10.3174/ajnr.A0869. Epub 2007 Nov 7.
Wingspan is a self-expanding, microcatheter-delivered microstent specifically designed for the treatment of symptomatic intracranial atherosclerotic disease. Our aim was to discuss the effect of patient age and lesion location on in-stent restenosis (ISR) rates after percutaneous transluminal angioplasty and stenting (PTAS) with the Wingspan system.
Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions. ISR was defined as >50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent and >20% absolute luminal loss. For the present analysis, patients were stratified into younger (</=55 years) and older (>55 years) age groups.
ISR occurred at a rate of 45.2% (14/31) in the younger group and 24.2% (15/62) in the older group (odds ratio, 2.6; 95% confidence interval, 1.03-6.5). In the younger group, ISR occurred after treatment of 13/26 (50%) anterior circulation lesions versus only 1/5 (20%) posterior circulation lesions. In the older group, ISR occurred in 9/29 (31.0%) anterior circulation lesions and 6/33 (18.2%) posterior circulation lesions. In young patients, internal carotid artery lesions (10/17 treated, 58.8%), especially those involving the supraclinoid segment (8/9, 88.9%), were very prone to ISR. When patients of all ages were considered, supraclinoid segment lesions had much higher rates of both ISR (66.6% versus 24.4%) and symptomatic ISR (40% versus 3.9%) in comparison with all other locations.
Post-Wingspan ISR is more common in younger patients. This increased risk can be accounted for by a high prevalence of anterior circulation lesions in this population, specifically those affecting the supraclinoid segment, which are much more prone to ISR and symptomatic ISR than all other lesions.
Wingspan是一种可通过微导管输送的自膨胀微支架，专门设计用于治疗有症状的颅内动脉粥样硬化疾病。我们的目的是探讨患者年龄和病变部位对采用Wingspan系统进行经皮腔内血管成形术和支架置入术（PTAS）后支架内再狭窄（ISR）发生率的影响。
记录了来自5个参与机构的所有患者的临床和血管造影随访结果。ISR定义为植入支架内或紧邻支架（5mm内）出现>50%的狭窄以及管腔绝对损失>20%。在本次分析中，患者被分为较年轻（≤55岁）和较年长（>55岁）年龄组。
较年轻组的ISR发生率为45.2%（14/31），较年长组为24.2%（15/62）（优势比，2.6；95%置信区间，1.03 - 6.5）。在较年轻组中，13/26（50%）的前循环病变治疗后发生ISR，而后循环病变仅1/5（20%）发生ISR。在较年长组中，9/29（31.0%）的前循环病变和6/33（18.2%）的后循环病变发生ISR。在年轻患者中，颈内动脉病变（10/17接受治疗，58.8%），尤其是累及床突上段的病变（8/9，88.9%），非常容易发生ISR。当考虑所有年龄段的患者时，与所有其他部位相比，床突上段病变的ISR（66.6%对24.4%）和有症状ISR（40%对3.9%）发生率都高得多。
Wingspan术后ISR在较年轻患者中更常见。该人群中前循环病变的高患病率可解释这种增加的风险，特别是那些影响床突上段的病变，其比所有其他病变更容易发生ISR和有症状ISR。
