Outcomes Of Individual Use Of Wingspan Or Enterprise In Symptomatic Middle Cerebral Artery Stenosis

Background and purpose: SAMMPRIS(the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis)showed better benefit of aggressive medical management over stenting in symptomatic intracranial atherosclerotic stenosis(ICAS) with significantly lower 30-day stroke or death rate(5.8% vs. 14.7%)and cumulative primary endpoints at one year(12.2% vs. 20.0%)in medical management. Individual use of appropriate stent may change outcomes of intracranial stenting. Thus, we prospectively study outcomes of appropriate self-expanding stent in symptomatic middle cerebral artery(MCA) stenosis based on experiences of operators.Materials and methods: Between January 2012 and April 2015, consecutively 85 patients with symptomatic MCA stenosis was treated by percutaneous transluminal angioplasty and stenting when the effect of aggressive medical management was poor in our research center. Depending on individual experience, operators choose open cell Wingspan stent or close cell Enterprise stent. All patients was followed up until December 2015. The primary endpoints were any stroke or death within 30 days and ipsilateral stroke after 30 days; the secondary endpoints were in-stent restenosis(ISR) evaluated by angiographic follow-up.Results: In this cohort, thirty five patients was treated by Wingspan and fifty patients was treated by Enterprise. The stent place success rate was 100%. During a mean of 23.20 ± 9.60 months follow-up, eight patients 【9.4%(8/85)】 had the primary endpoints. Three cases 【3.5%(3/85)】 occurred within 30 days and five cases 【5.9%(5/85)】 occurred after 30 days. Cumulative primary endpoints at one year was 8.2%(95% CI:5.2% ~ 11.2 %), which was lower than medical management 【12.2%(95% CI:8.4 ~ 17.6)】 in SAMMPRIS. At a mean of 9.44 ± 3.16 months after surgery, thirty nine patients had angiography and ISR developed in nine patients 【23.1%(9/39)】. Compared with Wingspan stent group, there were more locations in bifurcation【5.7%(2/35)vs. 32.0%(16/50);P=0.016)】, more long lesions of > 10 mm 【8.6%(3/35)vs. 38.0%(19/50); P=0.001】, and higher residual stenosis(18.0% vs. 24.8%;P=0.008)in Enterprise stent. But there were no differences in the primary endpoints 【8.6%(3/35)vs. 10%(5/50)】, the primary endpoints within 30 days 【2.9%(1/35)vs. 4.0%(2/50)】, and the secondary endpoints 【23.5%(4/17)vs. 22.7%(5/22)】between two stents.Conclusion: Individual use of either Wingspan or Enterprise in symptomatic MCA stenosis may has better effect with a lower cumulative primary endpoints and 30-day stroke or death rate of 3.5% compared with medical treatment in SAMMPRIS. There were no differences in the safety, long-term outcome and durability between the Wingspan and Enterprise group. Thus, Enterprise can be used in treating long lesions, angulation lesions.