Albuquerque Felipe C, Levy Elad I, Turk Aquilla S, Niemann David B, Aagaard-Kienitz Beverly, Pride G Lee, Purdy Phillip D, Welch Babu G, Woo Henry H, Rasmussen Peter A, Hopkins L Nelson, Masaryk Thomas J, McDougall Cameron G, Fiorella David J
Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Neurosurgery. 2008 Jul;63(1):23-7; discussion 27-8. doi: 10.1227/01.NEU.0000335067.53190.A2.
A classification system developed to characterize in-stent restenosis (ISR) after coronary percutaneous transluminal angioplasty with stenting was modified and applied to describe the appearance and distribution of ISR occurring after Wingspan (Boston Scientific, Fremont, CA) intracranial percutaneous transluminal angioplasty with stenting.
A prospective, intention-to-treat, multicenter registry of Wingspan treatment for symptomatic intracranial atherosclerotic disease was maintained. Clinical and angiographic follow-up results were recorded. ISR was defined as greater than 50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent(s) and greater than 20% absolute luminal loss. ISR lesions were classified by angiographic pattern, location, and severity in comparison with the original lesion treated.
Imaging follow-up (3-15.5 months) was available for 127 intracranial stenotic lesions treated with Wingspan percutaneous transluminal angioplasty with stenting. Forty-one lesions (32.3%) developed either ISR (n = 36 [28.3%]) or complete stent occlusion (n = 5 [3.9%]) after treatment. When restenotic lesions were characterized using the modified classification system, 25 of 41 (61.0%) were focal lesions involving less than 50% of the length of the stented segment: three were Type IA (focal stenosis involving one end of the stent), 21 were Type IB (focal intrastent stenosis involving a segment completely contained within the stent), and one was Type IC (multiple noncontiguous focal stenoses). Eleven lesions (26.8%) demonstrated diffuse stenosis (>50% of the length of the stented segment): nine were Type II with diffuse intrastent stenosis (completely contained within the stent) and two were Type III with proliferative ISR (extending beyond the stented segment). Five stents were completely occluded at follow-up (Type IV). Of the 36 ISR lesions, 16 were less severe or no worse than the original lesion with respect to severity of stenosis or length of the segment involved; 20 lesions were more severe than the original lesion with respect to the segment length involved (n = 5), actual stenosis severity (n = 6), or both (n = 9). Nine of 10 supraclinoid internal carotid artery ISR lesions and nine of 13 middle cerebral artery ISR lesions were more severe than the original lesion.
Wingspan ISR typically occurs as a focal lesion. In more than half of ISR cases, the ISR lesion was more extensive than the original lesion treated in terms of lesion length or stenosis severity. Supraclinoid internal carotid artery and middle cerebral artery lesions have a propensity to develop more severe posttreatment stenosis.
对一种用于描述冠状动脉支架置入术后支架内再狭窄（ISR）特征的分类系统进行修改，并应用于描述Wingspan（波士顿科学公司，弗里蒙特，加利福尼亚州）颅内经皮腔内血管成形术及支架置入术后ISR的表现和分布情况。
维持一项针对有症状颅内动脉粥样硬化疾病的Wingspan治疗的前瞻性、意向性治疗、多中心登记研究。记录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）狭窄超过50%且绝对管腔损失超过20%。与最初治疗的病变相比，根据血管造影模式、位置和严重程度对ISR病变进行分类。
对127例接受Wingspan经皮腔内血管成形术及支架置入术治疗的颅内狭窄病变进行了影像学随访（3 - 15.5个月）。41例病变（32.3%）在治疗后出现ISR（n = 36 [28.3%]）或完全支架闭塞（n = 5 [3.9%]）。当使用修改后的分类系统对再狭窄病变进行特征描述时，41例中的25例（61.0%）为局灶性病变，累及支架段长度小于50%：3例为IA型（累及支架一端的局灶性狭窄），21例为IB型（累及完全包含在支架内的一段的局灶性支架内狭窄），1例为IC型（多个不连续的局灶性狭窄）。11例病变（26.8%）表现为弥漫性狭窄（>支架段长度的50%）：9例为II型，有弥漫性支架内狭窄（完全包含在支架内），2例为III型，有增殖性ISR（延伸至支架段以外）。5个支架在随访时完全闭塞（IV型）。在36例ISR病变中，16例在狭窄严重程度或受累段长度方面不比最初病变严重或更严重；20例病变在受累段长度（n = 5）、实际狭窄严重程度（n = 6）或两者（n = 9）方面比最初病变更严重。10例床突上段颈内动脉ISR病变中的9例和13例大脑中动脉ISR病变中的9例比最初病变更严重。
Wingspan ISR通常表现为局灶性病变。在超过一半的ISR病例中，就病变长度或狭窄严重程度而言，ISR病变比最初治疗的病变更广泛。床突上段颈内动脉和大脑中动脉病变更倾向于出现更严重的治疗后狭窄。
