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BACKGROUND: Balloon dilatation and deployment of a self-expanding stent is a safe treatment for intracranial atherosclerotic stenoses. The significant recurrence rate might be related to the high radial force of the Wingspan stent.
OBJECTIVE: To evaluate the procedural safety and stenosis recurrence rate using a stent with reduced radial force (Enterprise).
METHODS: 209 atherosclerotic stenoses (189 patients) were treated (median age: 68 years; 132 male) in a single center. Lesion locations included ICA (n=27), MCA (n=62), VA (n=64), BA (n=55) and PCA (n=1). Pre- and post-medication included ASA and Clopidogrel for at least 12 months. Preprocedural and follow-up examinations included MRI, neurological assessment, and DSA (6, 12, 26, 52 weeks). Data registry included age, gender, normal vessel diameter, degree of stenosis, residual stenosis after stent, minimal in-stent diameter and occurrence of ischemic symptoms during follow-up.
RESULTS: Median pre- and postprocedural stenosis rate was 65.4+/-1% vs. 25.1+/-1%. Technical success rate was 100%. Major procedural complications occurred in 16 patients (8.1%). Combined neurological morbidity and mortality rate at 30 days was 2 patients (0.9%). In 174 stenoses (83%) angiographic follow-up was obtained (mean 10.2 months). A restenosis (>50%) was observed in 43 (24.7%) cases after 4.2 months (mean) with 4 (9.3%) symptomatic lesions. Incidence of recurrent ischemia related to the stented artery was 2.2% during 10.2 months of mean follow-up.
CONCLUSION: Undersized balloon angioplasty and deployment of an Enterprise stent is safe and effective for intracranial stenoses. Follow-up results were equal to or better than those reported for bare metal balloon-expandable or self-expanding stents and yielded excellent protection from recurrent ischemia.
Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.
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