Fiorella David J, Levy Elad I, Turk Aquilla S, Albuquerque Felipe C, Pride G Lee, Woo Henry H, Welch Babu G, Niemann David B, Purdy Phillip D, Aagaard-Kienitz Beverly, Rasmussen Peter A, Hopkins L Nelson, Masaryk Thomas J, McDougall Cameron G
Barrow Neurosurgical Associates, Ltd, Phoenix-Main Office, 2910 N. 3 Avenue, Phoenix, AZ 85013, USA.
Stroke. 2009 Jan;40(1):106-10. doi: 10.1161/STROKEAHA.108.525774. Epub 2008 Oct 16.
In-stent restenosis (ISR) occurs in approximately one-third of patients after the percutaneous transluminal angioplasty and stenting of intracranial atherosclerotic lesions with the Wingspan system. We review our experience with target lesion revascularization (TLR) for ISR after Wingspan treatment.
Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions in our US Wingspan Registry. ISR was defined as >50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent and >20% absolute luminal loss.
To date, 36 patients in the registry have experienced ISR after percutaneous transluminal angioplasty and stenting with Wingspan. Of these patients, 29 (80.6%) have undergone TLR with either angioplasty alone (n=26) or angioplasty with restenting (n=3). Restenting was performed for in-stent dissections that occurred after the initial angioplasty. Of the 29 patients undergoing TLR, 9 required >/=1 interventions for recurrent ISR, for a total of 42 interventions. One major complication, a postprocedural reperfusion hemorrhage, was encountered in the periprocedural period (2.4% per procedure; 3.5% per patient). Angiographic follow-up is available for 22 of 29 patients after TLR. Eleven of 22 (50%) demonstrated recurrent ISR at follow-up angiography. Nine patients have undergone multiple retreatments (2 retreatments, n=6; 3 retreatments, n=2; 4 retreatments, n=1) for recurrent ISR. Nine of 11 recurrent ISR lesions were located within the anterior circulation. The mean age for patients with recurrent anterior circulation ISR was 57.9 years (vs 81 years for posterior circulation ISR).
TLR can be performed for the treatment of intracranial Wingspan ISR with a relatively high degree of safety. However, the TLR results are not durable in approximately 50% of patients, and multiple revascularization procedures may be required in this subgroup.
使用Wingspan系统对颅内动脉粥样硬化病变进行经皮腔内血管成形术和支架置入术后，约三分之一的患者会发生支架内再狭窄（ISR）。我们回顾了Wingspan治疗后针对ISR进行靶病变血管重建术（TLR）的经验。
记录来自美国Wingspan注册研究中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）狭窄>50%且绝对管腔损失>20%。
迄今为止，该注册研究中有36例患者在使用Wingspan进行经皮腔内血管成形术和支架置入术后发生了ISR。在这些患者中，29例（80.6%）接受了单纯血管成形术（n = 26）或血管成形术联合再次支架置入术（n = 3）的TLR。再次支架置入术用于初始血管成形术后发生的支架内夹层。在接受TLR的29例患者中，9例因复发性ISR需要≥1次干预，总共进行了42次干预。围手术期发生1例主要并发症，即术后再灌注出血（每次手术发生率为2.%；每位患者发生率为3.5%）。29例接受TLR的患者中有22例可进行血管造影随访。22例中的11例（50%）在随访血管造影时显示复发性ISR。9例患者因复发性ISR接受了多次再治疗（2次再治疗，n = 6；3次再治疗，n = 2；4次再治疗 = 1）。11例复发性ISR病变中有9例位于前循环。前循环复发性ISR患者的平均年龄为57.9岁（后循环ISR患者为81岁）。
TLR可用于治疗颅内Wingspan ISR，安全性相对较高。然而，约50%的患者TLR效果不持久，该亚组患者可能需要多次血管重建手术。
