Accepted Manuscript Title: Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting Author: Zi-Liang Wang Bu-Lang Gao Tian-Xiao Li Dong-Yang Cai Liang-Fu Zhu Wei-Xing Bai Jiang-Yu Xue Zhao-Shuo Li PII: DOI: Reference:
S0720-048X(15)30005-X http://dx.doi.org/doi:10.1016/j.ejrad.2015.05.033 EURR 7148
To appear in:
European Journal of Radiology
Received date: Revised date: Accepted date:
2-2-2015 3-5-2015 29-5-2015
Please cite this article as: Wang Zi-Liang, Gao Bu-Lang, Li Tian-Xiao, Cai DongYang, Zhu Liang-Fu, Bai Wei-Xing, Xue Jiang-Yu, Li Zhao-Shuo.Symptomatic intracranial vertebral artery atherosclerotic stenosis (geq70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting.European Journal of Radiology http://dx.doi.org/10.1016/j.ejrad.2015.05.033 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Full title page 1. Title: Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting 2. Authors: Zi-Liang Wang*, Bu-Lang Gao*,Tian-Xiao Li, Dong-Yang Cai, Liang-Fu Zhu, Wei-Xing Bai, Jiang-Yu Xue, Zhao-Shuo Li 3. *These authors contributed equally to this work. 4. Affiliations: Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (Zi-Liang Wang, Tian-Xiao Li, Dong-Yang Cai, Liang-Fu Zhu, Wei-Xing Bai, Jiang-Yu Xue, Zhao-Shuo Li), and Department of Medical Research (Bu-Lang Gao), Shijiazhuang First Hospital, Hebei Medical University 5. Corresponding author: Tian-Xiao Li Professor Stroke Center Zhengzhou University Henan Provincial People’s Hospital 7 Weiwu Road Zhengzhou, Henan Province, China 450003 Email: [email protected] 6. Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting 7. Zi-Liang Wang*, Bu-Lang Gao*,Tian-Xiao Li, Dong-Yang Cai, Liang-Fu Zhu, Wei-Xing Bai, Jiang-Yu Xue, Zhao-Shuo Li 8. *These authors contributed equally to this work.
9. Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (Zi-Liang Wang, Tian-Xiao Li, Dong-Yang Cai, Liang-Fu Zhu, Wei-Xing Bai, Jiang-Yu Xue, Zhao-Shuo Li), and Department of Medical Research (Bu-Lang Gao), Shijiazhuang First Hospital, Hebei Medical University 10.Corresponding author: Tian-Xiao Li Professor Stroke Center Zhengzhou University Henan Provincial People’s Hospital 7 Weiwu Road Zhengzhou, Henan Province, China 450003 Email: [email protected] Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the Wingspan stent
Highlights
► 1. Symptomatic vertebral artery stenosis can be treated with intracranial stenting. 2. Stenting for intracranial vertebral artery stenosis is safe and effective.
3. Stenting for intracranial vertebral artery stenosis can prevent long-term stroke. Abstract Purpose To investigate the safety, effect and instent restenosis rate of Wingspan stenting in treating patients with intracranial vertebral artery atherosclerotic stenosis (70%-99%) concurrent with contralateral vertebral artery atherosclerotic diseases. Materials and methods Eighty-eight patients with severe symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) combined with contralateral vertebral artery atherosclerotic diseases were treated with the Wingpsan stent. All the baseline, cerebral angiography, success rate, perioperative complications, clinical and imaging follow-up data were prospectively analyzed. Results The success rate of stenting was 100%, and the mean stenotic rate was reduced from prestenting (84.9±6.8)% to poststenting (17.2±5.9)%. The perioperative stroke rate was 1.1%. Among eighty patients (90.9%) with clinical follow-up 8-62 months (mean 29.3±17.2) poststenting, five (6.3%) had posterior circulation TIA only, three (3.8%) had mild stroke in the posterior circulation but recovered completely, and another five patients greater than 70 years old died of non-ischemic stroke. Imaging follow-up in 46 patients (52.3%) 5-54 months (mean 9.9±9.9) following stenting revealed instent restenosis in 12 patients (26.1%) including 7 (58.3%) symptomatic restenosis. Age and residual stenosis were the two factors to significantly (P 50% compared with prestenting baseline at a site within the stent or within 5 mm immediately adjacent to the stent and the degree of stenosis > 20% of absolute luminal loss since stenting 7, 12.
The primary endpoint was ischemic stroke or death within and beyond 30 days after stenting. The secondary endpoint was the status of the stented segment on imaging at follow-up in terms of change in luminal diameter. Statistical analysis The statistics analysis was performed with the SPSS version 13.0 (SPSS, Chicago, IL, USA). The baseline, imaging and stenting data of all patients were presented as means (±SD) for continuous variables and number for categorical data. Continuous variables were tested with the Student t-test while categorical data with χ2 test or Fisher exact test. Factors affecting restenosis were analyzed with the logistic regression method. The significant P value was set at < 0.05.
Results Eighty-eight patients with severe intracranial vertebral stenosis (70%-99%) were treated with intracranial Wingspan stenting, including 66 males and 22 females with an age range of 41-82 years (mean 62.6±10.1) (Table 1). TIA was presented in 54 patients while ischemic stroke was in the remaining 34 for the presenting symptoms. Among these patients, the stenosis was at the vertebrobasilar junction in 36 patients (Table 2). All 88 patients had the Wingspan stent deployed successfully (100%), and the mean stenotic rate was improved from prestenting (82.2±5.8)% to poststenting (15.9±5.7)% (Table 2). The residual stenosis was (22.0±3.9)% at the vertebrobasilar junction significantly higher than in the middle and lower segments of the intracranial vertebral
artery (12.8±3.5)% (t=8.4, 95% CI: 7.0-11.5). The severe V4 segment stenosis of the contralateral vertebral artery in two patients was treated with a balloon-expandable stent while a Wingspan stent was deployed for the severe vertebral artery stenosis. No adverse events occurred in these two patients either within or after the procedure. During the 30-day perioperative period, no stroke took place in any patient except one patient (1.1%) who had, within two days, recurrent temporary unconsciousness and weakness in the left extremities lasting less than 30 minutes. Because head CT revealed no intracranial hemorrhage and intrastent thrombosis was suspected in this patient, anticoagulation and antiplatelet therapies were administered and resolved the symptoms soon. No neurological deficits presented before discharge in this patient, however, head MRI one year later demonstrated two small infarct loci in the left thalamus and in the right basal ganglion region. Another two patients had ipsilateral TIA with limb weakness in one patient and transient vertigo in the other lasting less than 10 minutes. One patient had retroperitoneal hematoma and recovered completely afte te hematoma was removed surgically. Except for eight patients who were lost to follow-up, eighty patients (90.9%) had clinical follow-up 8-62 months (mean 29.3±17.2) poststenting. Among these patients, five (6.3%) had posterior circulation TIA only, but three (3.8%) had mild stroke in the posterior circulation and recovered completely. Five patients with age greater than 70 years old (76, 77, 79, 79 and 80 years)died of non-ischemic stroke. Among eleven
patients older than 76 years who had clinical follow-up, 5 (45.5%) died of other diseases unrelated to the stenting arteries. Imaging follow-up was performed in 46 patients (52.3%) 5-54 months (mean 9.9±9.9) following stenting, including DSA in 32 cases and CT angiography in 14. Twelve patients (26.1%) had instent restenosis including 7 (58.3%) symptomatic restenosis revealed by DSA. CT angiography demonstrated no instent restenosis. Six patients were retreated endovascularly, with Wingspan stenting in two patients but angioplasty only in the other four, and no operative complications took place. Logistic regression analysis was performed for multiple relevant factors affecting instent restenosis, and two significant (P
S0720-048X(15)30005-X http://dx.doi.org/doi:10.1016/j.ejrad.2015.05.033 EURR 7148
To appear in:
European Journal of Radiology
Received date: Revised date: Accepted date:
2-2-2015 3-5-2015 29-5-2015
Please cite this article as: Wang Zi-Liang, Gao Bu-Lang, Li Tian-Xiao, Cai DongYang, Zhu Liang-Fu, Bai Wei-Xing, Xue Jiang-Yu, Li Zhao-Shuo.Symptomatic intracranial vertebral artery atherosclerotic stenosis (geq70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting.European Journal of Radiology http://dx.doi.org/10.1016/j.ejrad.2015.05.033 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Full title page 1. Title: Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting 2. Authors: Zi-Liang Wang*, Bu-Lang Gao*,Tian-Xiao Li, Dong-Yang Cai, Liang-Fu Zhu, Wei-Xing Bai, Jiang-Yu Xue, Zhao-Shuo Li 3. *These authors contributed equally to this work. 4. Affiliations: Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (Zi-Liang Wang, Tian-Xiao Li, Dong-Yang Cai, Liang-Fu Zhu, Wei-Xing Bai, Jiang-Yu Xue, Zhao-Shuo Li), and Department of Medical Research (Bu-Lang Gao), Shijiazhuang First Hospital, Hebei Medical University 5. Corresponding author: Tian-Xiao Li Professor Stroke Center Zhengzhou University Henan Provincial People’s Hospital 7 Weiwu Road Zhengzhou, Henan Province, China 450003 Email: [email protected] 6. Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting 7. Zi-Liang Wang*, Bu-Lang Gao*,Tian-Xiao Li, Dong-Yang Cai, Liang-Fu Zhu, Wei-Xing Bai, Jiang-Yu Xue, Zhao-Shuo Li 8. *These authors contributed equally to this work.
9. Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (Zi-Liang Wang, Tian-Xiao Li, Dong-Yang Cai, Liang-Fu Zhu, Wei-Xing Bai, Jiang-Yu Xue, Zhao-Shuo Li), and Department of Medical Research (Bu-Lang Gao), Shijiazhuang First Hospital, Hebei Medical University 10.Corresponding author: Tian-Xiao Li Professor Stroke Center Zhengzhou University Henan Provincial People’s Hospital 7 Weiwu Road Zhengzhou, Henan Province, China 450003 Email: [email protected] Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the Wingspan stent
Highlights
► 1. Symptomatic vertebral artery stenosis can be treated with intracranial stenting. 2. Stenting for intracranial vertebral artery stenosis is safe and effective.
3. Stenting for intracranial vertebral artery stenosis can prevent long-term stroke. Abstract Purpose To investigate the safety, effect and instent restenosis rate of Wingspan stenting in treating patients with intracranial vertebral artery atherosclerotic stenosis (70%-99%) concurrent with contralateral vertebral artery atherosclerotic diseases. Materials and methods Eighty-eight patients with severe symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) combined with contralateral vertebral artery atherosclerotic diseases were treated with the Wingpsan stent. All the baseline, cerebral angiography, success rate, perioperative complications, clinical and imaging follow-up data were prospectively analyzed. Results The success rate of stenting was 100%, and the mean stenotic rate was reduced from prestenting (84.9±6.8)% to poststenting (17.2±5.9)%. The perioperative stroke rate was 1.1%. Among eighty patients (90.9%) with clinical follow-up 8-62 months (mean 29.3±17.2) poststenting, five (6.3%) had posterior circulation TIA only, three (3.8%) had mild stroke in the posterior circulation but recovered completely, and another five patients greater than 70 years old died of non-ischemic stroke. Imaging follow-up in 46 patients (52.3%) 5-54 months (mean 9.9±9.9) following stenting revealed instent restenosis in 12 patients (26.1%) including 7 (58.3%) symptomatic restenosis. Age and residual stenosis were the two factors to significantly (P 50% compared with prestenting baseline at a site within the stent or within 5 mm immediately adjacent to the stent and the degree of stenosis > 20% of absolute luminal loss since stenting 7, 12.
The primary endpoint was ischemic stroke or death within and beyond 30 days after stenting. The secondary endpoint was the status of the stented segment on imaging at follow-up in terms of change in luminal diameter. Statistical analysis The statistics analysis was performed with the SPSS version 13.0 (SPSS, Chicago, IL, USA). The baseline, imaging and stenting data of all patients were presented as means (±SD) for continuous variables and number for categorical data. Continuous variables were tested with the Student t-test while categorical data with χ2 test or Fisher exact test. Factors affecting restenosis were analyzed with the logistic regression method. The significant P value was set at < 0.05.
Results Eighty-eight patients with severe intracranial vertebral stenosis (70%-99%) were treated with intracranial Wingspan stenting, including 66 males and 22 females with an age range of 41-82 years (mean 62.6±10.1) (Table 1). TIA was presented in 54 patients while ischemic stroke was in the remaining 34 for the presenting symptoms. Among these patients, the stenosis was at the vertebrobasilar junction in 36 patients (Table 2). All 88 patients had the Wingspan stent deployed successfully (100%), and the mean stenotic rate was improved from prestenting (82.2±5.8)% to poststenting (15.9±5.7)% (Table 2). The residual stenosis was (22.0±3.9)% at the vertebrobasilar junction significantly higher than in the middle and lower segments of the intracranial vertebral
artery (12.8±3.5)% (t=8.4, 95% CI: 7.0-11.5). The severe V4 segment stenosis of the contralateral vertebral artery in two patients was treated with a balloon-expandable stent while a Wingspan stent was deployed for the severe vertebral artery stenosis. No adverse events occurred in these two patients either within or after the procedure. During the 30-day perioperative period, no stroke took place in any patient except one patient (1.1%) who had, within two days, recurrent temporary unconsciousness and weakness in the left extremities lasting less than 30 minutes. Because head CT revealed no intracranial hemorrhage and intrastent thrombosis was suspected in this patient, anticoagulation and antiplatelet therapies were administered and resolved the symptoms soon. No neurological deficits presented before discharge in this patient, however, head MRI one year later demonstrated two small infarct loci in the left thalamus and in the right basal ganglion region. Another two patients had ipsilateral TIA with limb weakness in one patient and transient vertigo in the other lasting less than 10 minutes. One patient had retroperitoneal hematoma and recovered completely afte te hematoma was removed surgically. Except for eight patients who were lost to follow-up, eighty patients (90.9%) had clinical follow-up 8-62 months (mean 29.3±17.2) poststenting. Among these patients, five (6.3%) had posterior circulation TIA only, but three (3.8%) had mild stroke in the posterior circulation and recovered completely. Five patients with age greater than 70 years old (76, 77, 79, 79 and 80 years)died of non-ischemic stroke. Among eleven
patients older than 76 years who had clinical follow-up, 5 (45.5%) died of other diseases unrelated to the stenting arteries. Imaging follow-up was performed in 46 patients (52.3%) 5-54 months (mean 9.9±9.9) following stenting, including DSA in 32 cases and CT angiography in 14. Twelve patients (26.1%) had instent restenosis including 7 (58.3%) symptomatic restenosis revealed by DSA. CT angiography demonstrated no instent restenosis. Six patients were retreated endovascularly, with Wingspan stenting in two patients but angioplasty only in the other four, and no operative complications took place. Logistic regression analysis was performed for multiple relevant factors affecting instent restenosis, and two significant (P
