postdilation of the wingspan- stent instead of predilation is feasible and safe
DESCRIPTION
Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe. Andreas Ragoschke-Schumm 1 , Stephanie Schindhelm 1 , Peter Schmidt 1 , Sascha Schiffler 1 , Andreas Hansch 1 , Robert Drescher 1 , Martin Bokemeyer 1 , Albrecht Günther 2 , Jens Weise 2 , Thomas E. Mayer 1. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/1.jpg)
Postdilation of the WINGSPAN-Stent instead of predilation is
feasible and safe
Andreas Ragoschke-Schumm1, Stephanie Schindhelm1, Peter Schmidt1, Sascha Schiffler1, Andreas Hansch1, Robert Drescher1, Martin
Bokemeyer1, Albrecht Günther2, Jens Weise2, Thomas E. Mayer1 Friedrich-Schiller-University, Jena, Germany
1Department of Neuroradiology, 2Department of Neurology
![Page 2: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/2.jpg)
Symptomatic intracranial stenoses
• Important cause of stroke, especially in blacks, Asians, and Hispanics. – 10% in the white population– 30% in the chinese population
• WASID trial: no benefit of warfarin over ASS but more complications ASS conventional therapy of choice
Chimowitz et al. NEJM, 2005
![Page 3: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/3.jpg)
Chimowitz et al. NEJM, 2005
Risk of stroke recurrence
![Page 4: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/4.jpg)
• Subgroup analyses from WASID: 1 year risk
– Stenoses 70-99 % 18 %– Stenoses 70-99 % and qualifying event within
30 d before study enrollment 23%!
Risk of stroke recurrence
Kasner et al. Circulation, 2006Kasner et al. Neurology, 2006
![Page 5: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/5.jpg)
Need for more effective Treatment!
One Approach:Intracranial PTA and stenting
![Page 6: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/6.jpg)
WINGSPAN-Stent
• Self expanding Nitinol-Stent, Over-The-Wire• Indication: symptomatic intracranial stenoses• Diameter: 2.5 mm – 4.5 mm, length 9, 15, 20 mm
![Page 7: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/7.jpg)
According to manufacturer and
WINGSPAN-Study
WINGSPAN-Stentmode of deployment
![Page 8: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/8.jpg)
WINGSPAN-Stentmode of deployment
![Page 9: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/9.jpg)
WINGSPAN-Stentmode of deployment
![Page 10: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/10.jpg)
WINGSPAN-Stentmode of deployment
![Page 11: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/11.jpg)
WINGSPAN-Stentmode of deployment
![Page 12: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/12.jpg)
Problem• Predilation poses potential risk of unprotected dissection, vessel occlusion or vessel
rupture
• There are cases where stenting alone could lead to sufficcient treatment of the stenosis
Questions
• Does primary Stent-deployment help avoid dilation at all?
• Does postdilation harm the stent or the patient?
![Page 13: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/13.jpg)
According to our
modification
WINGSPAN-Stentmode of deployment
![Page 14: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/14.jpg)
WINGSPAN-Stentmode of deployment
![Page 15: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/15.jpg)
WINGSPAN-Stentmode of deployment
![Page 16: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/16.jpg)
WINGSPAN-Stentmode of deployment
![Page 17: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/17.jpg)
WINGSPAN-Stentmode of deployment
![Page 18: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/18.jpg)
Study
• Retrospective• All Patients that were treated with wingspan stents were
assessed for technical success• All Patients treated for symptomatic intracranial stenoses
were assessed for treatment assocciated complications, periprocedural outcome and restenoses.
• Indication: interdisciplinary with a neurologist• Postprocedural follow-up (DSA after 6 months,
Doppler/Duplex-Sonography and neurological examination every 3 months during the first year.
![Page 19: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/19.jpg)
results
• Observation time 02/2008 - 09/2010• 34 Patients (25 m, 9 f), Wingspan N=40• 24 patients were treated with subacute
symptomatic stenoses (>24 hrs.)• 9 with acute vessel occlusion (all
vertebrobasilar)• 1 with acute aneurysmal SAH (dissection during
endovascular embolisation)
![Page 20: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/20.jpg)
Subacute intracranial stenoses
• Average stenosis rate 75% (55%-99%)• Age: average 60.7 yrs, (ranging from 43 to
80 yrs.)• Postinterventional follow-up (max. 158 d,
median 133 d)• No follow-up in 1 patient
![Page 21: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/21.jpg)
• Stent localisation (28/40) 70% anterior – (12/40) 30% posterior circulation
• Technical success (40/40) 100%• Predilation (2/40) 5%• Postdilation (21/40) 52.5%• Dissection C2-Segment during postdilation
(asymptomatic but treated with a stent)• Stent deformation (2/40) 5%
technical results
![Page 22: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/22.jpg)
Preinterventional
![Page 23: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/23.jpg)
Treatment of stenosis, postdilation
![Page 24: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/24.jpg)
Follow up after 3 months
![Page 25: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/25.jpg)
Subacute intracranial stenoses-Group
• 1 major stroke (basilar artery) with extensive new infarcts in the brainstem and posterior circulation. Death
• 1 Patient (proximal MCA) with mild transient neurologic impairment and small new DWI-Lesions in postprocedural MRI
(2/24) 8.3%• 1 Patient with mild hyperperfusion Syndrome
(headaches) 4.2%• Restenoses (3/24) 12.5%• No intracranial bleedings
![Page 26: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/26.jpg)
Discussion
• In 42.5% of Stents no dilation was needed
• The rate of 8.3% of periprocedural strokes is within the range of complications reported for intracranial stenting
• Restenosis-rate of 12.5% is remarcably low but could increase with longer follow-up.
• Visible Stent deformation in 5% but did not impair clinical outcome.
![Page 27: Postdilation of the WINGSPAN- Stent instead of predilation is feasible and safe](https://reader031.vdocuments.site/reader031/viewer/2022033101/56815911550346895dc63ccb/html5/thumbnails/27.jpg)
Conclusion
• Post- instead of Predilation of the Wingspan-Stent in intracranial stenoses helps avoiding PTA and seems to be safe
??? Lower rate of restenoses ???