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David Fiorella - One of the best experts on this subject based on the ideXlab platform.
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Impact of operator and site experience on outcomes after angioplasty and stenting in the SAMMPRIS trial
Journal of neurointerventional surgery, 2012Co-Authors: Colin P. Derdeyn, Osama O. Zaidat, David Fiorella, Stanley L Barnwell, Bethany F Lane, Michael J Lynn, Philip M. Meyers, Y. Pierre Gobin, Jacques E. Dion, Tanya N. TuranAbstract:Background and purpose To investigate the relationship between physician and site experience and the risk of 30 day hemorrhagic and ischemic strokes in the stenting arm of the Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS) trial. Methods Study records and an investigator survey were examined for physician and site related factors, including: number of Wingspan and aneurysm stents submitted for credentialing, number of study procedures performed in SAMMPRIS, years in practice after training, primary specialty, and site enrollment. Bivariate and multivariate analyses were performed to determine if these factors were associated with the 30 day rate of cerebrovascular events after angioplasty and stenting. Results 213 patients underwent angioplasty alone (n=5) or angioplasty and stenting (n=208) with study devices by 63 interventionists at 48 sites. For credentialing, the median number of Wingspan and similar aneurysm stent cases submitted by study interventionists were 10 and 6, respectively. Interventionists with higher numbers (>10) of Wingspan cases submitted for credentialing tended to have higher rates of 30 day events (19.0% vs 9.9%) than those with 12 patients). Conclusions Interventionists credentialed with less Wingspan experience were not responsible for the high rate of periprocedural stroke in SAMMPRIS. Hemorrhagic stroke may be related to low enrollment in the trial but not previous Wingspan experience.
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Endovascular treatment of intracranial stenosis.
World Neurosurgery, 2011Co-Authors: David FiorellaAbstract:The Gateway balloon-Wingspan stent system is the first, and currently the only "on-label" device for the treatment of symptomatic intracranial stenosis in the United States. In initial single-arm studies, investigators have indicated that this system can be used for the treatment of symptomatic intracranial atherosclerotic disease with high levels of technical success and acceptable periprocedural complication rates, which are comparable with, or better than, those reported for other endovascular techniques. Intermediate- and long-term follow-up data for patients treated with the Wingspan device remain sparse. We critically review the existing data, which characterize the risk profile and efficacy of endovascular interventions for intracranial atherosclerotic disease, as well as the available clinical evidence that could be used to select appropriate patients for treatment.
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impact of wasid and Wingspan on the frequency of intracranial angioplasty and stenting at a high volume tertiary care hospital
Journal of NeuroInterventional Surgery, 2009Co-Authors: Shaye I. Moskowitz, Michael Kelly, Nancy A. Obuchowski, David FiorellaAbstract:Background and Purpose The impact of the Warfarin and Aspirin for Symptomatic Intracranial Disease (WASID) data is described in combination with the commercial release of the Wingspan stenting system on the frequency of neurointervention for the treatment of symptomatic intracranial atherosclerotic disease (ICAD) in a tertiary care center. Methods Endovascular case logs were reviewed from April 2004 to July 2007. The total number of intracranial neurointerventions and the number of neurointerventions (percutaneous transluminal angioplasty alone (PTA) or with stenting (PTAS)) performed for symptomatic ICAD were calculated. The time period evaluated was divided into two equal 19.5-month epochs representing the time periods before and after the availability of the Wingspan system. Results The frequency of neurointerventions for ICAD increased by 763%, from seven of 354 total cases (2%) to 56 of 367 total cases (15.3%) (p Conclusions The publication of the WASID trial results combined with the availability of the Wingspan stent system led to a marked increase in the frequency of neurointervention for symptomatic ICAD at our institution. The adoption of this technology occurred without direct evidence that PTAS with Wingspan is superior to traditional medical therapy. These findings underscore the need for a randomized trial of stenting and medical therapy for the treatment of this disease process.
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Impact of WASID and Wingspan on the frequency of intracranial angioplasty and stenting at a high volume tertiary care hospital.
Journal of neurointerventional surgery, 2009Co-Authors: Shaye I. Moskowitz, Michael Kelly, Nancy A. Obuchowski, David FiorellaAbstract:The impact of the Warfarin and Aspirin for Symptomatic Intracranial Disease (WASID) data is described in combination with the commercial release of the Wingspan stenting system on the frequency of neurointervention for the treatment of symptomatic intracranial atherosclerotic disease (ICAD) in a tertiary care center. Endovascular case logs were reviewed from April 2004 to July 2007. The total number of intracranial neurointerventions and the number of neurointerventions (percutaneous transluminal angioplasty alone (PTA) or with stenting (PTAS)) performed for symptomatic ICAD were calculated. The time period evaluated was divided into two equal 19.5-month epochs representing the time periods before and after the availability of the Wingspan system. The frequency of neurointerventions for ICAD increased by 763%, from seven of 354 total cases (2%) to 56 of 367 total cases (15.3%) (p<0.001) after the Wingspan system became available. The increase in intracranial PTAS volume occurred immediately and was stable throughout the "Wingspan era". The publication of the WASID trial results combined with the availability of the Wingspan stent system led to a marked increase in the frequency of neurointervention for symptomatic ICAD at our institution. The adoption of this technology occurred without direct evidence that PTAS with Wingspan is superior to traditional medical therapy. These findings underscore the need for a randomized trial of stenting and medical therapy for the treatment of this disease process.
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DynaCT evaluation of in-stent restenosis following Wingspan stenting of intracranial stenosis
Journal of neurointerventional surgery, 2009Co-Authors: Shaye I. Moskowitz, Michael Kelly, J Haynes, David FiorellaAbstract:Objective and importance To describe the use of DynaCT angiographic imaging for the evaluation of Wingspan in-stent restenosis (ISR). Methods Two patients were treated with Wingspan stenting and percutaneous transluminal angioplasty (Patient 1 had treatment of a severe stenosis of the right middle cerebral artery and patient 2 had severe stenosis of the left intracranial internal carotid artery. Both patients developed ISR and were evaluated with high resolution DynaCT angiographic imaging. Results DynaCT demonstrated circumferential soft tissue density material distributed within the stent as the cause of the stenosis visualized with conventional angiography. Conclusions These findings support the hypothesis that ISR is caused by neointimal proliferation, rather than vascular re-coil with stent collapse.
Osama O. Zaidat - One of the best experts on this subject based on the ideXlab platform.
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Impact of operator and site experience on outcomes after angioplasty and stenting in the SAMMPRIS trial
Journal of neurointerventional surgery, 2012Co-Authors: Colin P. Derdeyn, Osama O. Zaidat, David Fiorella, Stanley L Barnwell, Bethany F Lane, Michael J Lynn, Philip M. Meyers, Y. Pierre Gobin, Jacques E. Dion, Tanya N. TuranAbstract:Background and purpose To investigate the relationship between physician and site experience and the risk of 30 day hemorrhagic and ischemic strokes in the stenting arm of the Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS) trial. Methods Study records and an investigator survey were examined for physician and site related factors, including: number of Wingspan and aneurysm stents submitted for credentialing, number of study procedures performed in SAMMPRIS, years in practice after training, primary specialty, and site enrollment. Bivariate and multivariate analyses were performed to determine if these factors were associated with the 30 day rate of cerebrovascular events after angioplasty and stenting. Results 213 patients underwent angioplasty alone (n=5) or angioplasty and stenting (n=208) with study devices by 63 interventionists at 48 sites. For credentialing, the median number of Wingspan and similar aneurysm stent cases submitted by study interventionists were 10 and 6, respectively. Interventionists with higher numbers (>10) of Wingspan cases submitted for credentialing tended to have higher rates of 30 day events (19.0% vs 9.9%) than those with 12 patients). Conclusions Interventionists credentialed with less Wingspan experience were not responsible for the high rate of periprocedural stroke in SAMMPRIS. Hemorrhagic stroke may be related to low enrollment in the trial but not previous Wingspan experience.
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Long term clinical and angiographic outcomes with the Wingspan stent for treatment of symptomatic 50-99% intracranial atherosclerosis: single center experience in 51 cases.
Journal of neurointerventional surgery, 2009Co-Authors: Thomas Wolfe, B.f. Fitzsimmons, Syed I. Hussain, John R. Lynch, Osama O. ZaidatAbstract:Background and aim Two independent post-approval registries have reported favorable periprocedural and short term outcomes with the use of the Wingspan stent for treatment of intracranial arterial stenosis. Data on long term clinical and imaging outcomes after Wingspan stent placement are limited. Methods All patients treated with the Wingspan stent in a single academic center from January 2006 to February 2008 were identified. Data on stenting indication, severity of stenosis, technical success, re-stenosis and clinical outcome were collected. Results 51 patients were treated with the Wingspan stent system for a symptomatic intracranial atherosclerotic stenosis of 50–99%. The technical success rate was 98%. The mean pre- and post-stent stenoses were 73 (11)% and 21 (7)%. Any stroke or death within 24 h of the procedure occurred in 1/51 (2%). The frequency of any stroke or death within 30 days or ipsilateral stroke beyond 30 days was 5/51 (10.0%) at a mean follow-up time of 14.6 months (range 8–30). The frequency of ≥ 50% re-stenosis on follow-up imaging was 7/29 (24%) at 8.6 (4.4) months (range 3–20); all were detected on the initial imaging within 3–6 months, and only one was symptomatic. Conclusion The use of the Wingspan stent in patients with ≥50% symptomatic intracranial stenosis is associated with good long term clinical outcome. One stroke occurred after the first 30 days, suggesting a significant stabilization of the adverse event rate after the first month.
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long term clinical and angiographic outcomes with the Wingspan stent for treatment of symptomatic 50 99 intracranial atherosclerosis single center experience in 51 cases
Journal of NeuroInterventional Surgery, 2009Co-Authors: Thomas Wolfe, B.f. Fitzsimmons, Syed I. Hussain, John R. Lynch, Osama O. ZaidatAbstract:Background and aim Two independent post-approval registries have reported favorable periprocedural and short term outcomes with the use of the Wingspan stent for treatment of intracranial arterial stenosis. Data on long term clinical and imaging outcomes after Wingspan stent placement are limited. Methods All patients treated with the Wingspan stent in a single academic center from January 2006 to February 2008 were identified. Data on stenting indication, severity of stenosis, technical success, re-stenosis and clinical outcome were collected. Results 51 patients were treated with the Wingspan stent system for a symptomatic intracranial atherosclerotic stenosis of 50–99%. The technical success rate was 98%. The mean pre- and post-stent stenoses were 73 (11)% and 21 (7)%. Any stroke or death within 24 h of the procedure occurred in 1/51 (2%). The frequency of any stroke or death within 30 days or ipsilateral stroke beyond 30 days was 5/51 (10.0%) at a mean follow-up time of 14.6 months (range 8–30). The frequency of ≥ 50% re-stenosis on follow-up imaging was 7/29 (24%) at 8.6 (4.4) months (range 3–20); all were detected on the initial imaging within 3–6 months, and only one was symptomatic. Conclusion The use of the Wingspan stent in patients with ≥50% symptomatic intracranial stenosis is associated with good long term clinical outcome. One stroke occurred after the first 30 days, suggesting a significant stabilization of the adverse event rate after the first month.
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the nih registry on use of the Wingspan stent for symptomatic 70 99 intracranial arterial stenosis
Neurology, 2008Co-Authors: Osama O. Zaidat, Helmi L. Lutsep, Richard P Klucznik, Michael J Alexander, J Chaloupka, Stanley L Barnwell, M E Mawad, Bethany F Lane, Michael J Lynn, Marc I ChimowitzAbstract:Background: The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial showed that patients with symptomatic 70% to 99% intracranial arterial stenosis are at particularly high risk of ipsilateral stroke on medical therapy: 18% at 1 year (95% CI = 3% to 24%). The Wingspan intracranial stent is another therapeutic option but there are limited data on the technical success of stenting and outcome of patients with 70% to 99% stenosis treated with a Wingspan stent. Methods: Sixteen medical centers enrolled consecutive patients treated with a Wingspan stent in this registry between November 2005 and October 2006. Data on stenting indication, severity of stenosis, technical success (stent placement across the target lesion with Results: A total of 129 patients with symptomatic 70% to 99% intracranial stenosis were enrolled. The technical success rate was 96.7%. The mean pre and post-stent stenoses were 82% and 20%. The frequency of any stroke, intracerebral hemorrhage, or death within 30 days or ipsilateral stroke beyond 30 days was 14.0% at 6 months (95% CI = 8.7% to 22.1%). The frequency of ≥50% restenosis on follow-up angiography was 13/52 (25%). Conclusion: The use of a Wingspan stent in patients with severe intracranial stenosis is relatively safe with high rate of technical success with moderately high rate of restenosis. Comparison of the event rates in high-risk patients in Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) vs this registry do not rule out either that stenting could be associated with a substantial relative risk reduction (e.g., 50%) or has no advantage compared with medical therapy. A randomized trial comparing stenting with medical therapy is needed. GLOSSARY: FDA = Food and Drug Administration; HDE = Humanitarian Device Exemption; ICH = intracerebral hemorrhage; WASID = Warfarin-Aspirin Symptomatic Intracranial Disease.
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the nih registry on use of the Wingspan stent for symptomatic 70 99 intracranial arterial stenosis
Neurology, 2008Co-Authors: Osama O. Zaidat, Helmi L. Lutsep, Richard P Klucznik, Michael J Alexander, J Chaloupka, Stanley L Barnwell, M E Mawad, Bethany F Lane, Michael J Lynn, Marc I ChimowitzAbstract:Background: The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial showed that patients with symptomatic 70% to 99% intracranial arterial stenosis are at particularly high risk of ipsilateral stroke on medical therapy: 18% at 1 year (95% CI = 3% to 24%). The Wingspan intracranial stent is another therapeutic option but there are limited data on the technical success of stenting and outcome of patients with 70% to 99% stenosis treated with a Wingspan stent. Methods: Sixteen medical centers enrolled consecutive patients treated with a Wingspan stent in this registry between November 2005 and October 2006. Data on stenting indication, severity of stenosis, technical success (stent placement across the target lesion with Results: A total of 129 patients with symptomatic 70% to 99% intracranial stenosis were enrolled. The technical success rate was 96.7%. The mean pre and post-stent stenoses were 82% and 20%. The frequency of any stroke, intracerebral hemorrhage, or death within 30 days or ipsilateral stroke beyond 30 days was 14.0% at 6 months (95% CI = 8.7% to 22.1%). The frequency of ≥50% restenosis on follow-up angiography was 13/52 (25%). Conclusion: The use of a Wingspan stent in patients with severe intracranial stenosis is relatively safe with high rate of technical success with moderately high rate of restenosis. Comparison of the event rates in high-risk patients in Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) vs this registry do not rule out either that stenting could be associated with a substantial relative risk reduction (e.g., 50%) or has no advantage compared with medical therapy. A randomized trial comparing stenting with medical therapy is needed. GLOSSARY: FDA = Food and Drug Administration; HDE = Humanitarian Device Exemption; ICH = intracerebral hemorrhage; WASID = Warfarin-Aspirin Symptomatic Intracranial Disease.
Guilherme Dabus - One of the best experts on this subject based on the ideXlab platform.
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Wingspan experience in the treatment of symptomatic intracranial atherosclerotic disease after antithrombotic failure
Journal of NeuroInterventional Surgery, 2013Co-Authors: Edgar A. Samaniego, Italo Linfante, Christine F. Silva, Gabriela Spilberg, Matthew J. Gounis, Ajay K. Wakhloo, Francesca Taricapone, Guilherme DabusAbstract:Background and purpose Intracranial stenting with the Wingspan system has been used as a revascularization strategy in symptomatic patients with intracranial atherosclerotic disease (ICAD). The latest results of the Stenting versus Aggressive Medical Therapy for Intracranial Artery Stenosis (SAMMPRIS) trial challenge this approach. Our experience in the treatment of symptomatic ICAD with the Wingspan system is reported. Materials and methods Patients who underwent stenting for symptomatic ICAD were included in the analysis. Demographic data, periprocedural complications, long term radiological and clinical outcomes are reported. Results 46 lesions were treated in 45 patients. 13 patients (29%) presented with a transient ischemic attack and 32 (71%) with a stroke. 43 patients (95.5%) failed antithrombotic therapy at presentation. One (2%) symptomatic periprocedural (24 h) complication occurred. The 30 day incidence of stroke and vascular death was 6.6%—a fatal hemorrhagic stroke and two non-fatal hemorrhagic strokes. In-stent stenosis (≥50%) was seen in nine (42.8%) lesions, two were symptomatic. Conclusions This cohort of patients with symptomatic ICAD who failed antithrombotic medications benefited from angioplasty and stenting with the Wingspan system.
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Wingspan experience in the treatment of symptomatic intracranial atherosclerotic disease after antithrombotic failure.
Journal of neurointerventional surgery, 2012Co-Authors: Edgar A. Samaniego, Francesca Tari-capone, Italo Linfante, Christine F. Silva, Gabriela Spilberg, Matthew J. Gounis, Ajay K. Wakhloo, Guilherme DabusAbstract:Intracranial stenting with the Wingspan system has been used as a revascularization strategy in symptomatic patients with intracranial atherosclerotic disease (ICAD). The latest results of the Stenting versus Aggressive Medical Therapy for Intracranial Artery Stenosis (SAMMPRIS) trial challenge this approach. Our experience in the treatment of symptomatic ICAD with the Wingspan system is reported. Patients who underwent stenting for symptomatic ICAD were included in the analysis. Demographic data, periprocedural complications, long term radiological and clinical outcomes are reported. 46 lesions were treated in 45 patients. 13 patients (29%) presented with a transient ischemic attack and 32 (71%) with a stroke. 43 patients (95.5%) failed antithrombotic therapy at presentation. One (2%) symptomatic periprocedural (24 h) complication occurred. The 30 day incidence of stroke and vascular death was 6.6%--a fatal hemorrhagic stroke and two non-fatal hemorrhagic strokes. In-stent stenosis (≥50%) was seen in nine (42.8%) lesions, two were symptomatic. This cohort of patients with symptomatic ICAD who failed antithrombotic medications benefited from angioplasty and stenting with the Wingspan system.
Marc I Chimowitz - One of the best experts on this subject based on the ideXlab platform.
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the nih registry on use of the Wingspan stent for symptomatic 70 99 intracranial arterial stenosis
Neurology, 2008Co-Authors: Osama O. Zaidat, Helmi L. Lutsep, Richard P Klucznik, Michael J Alexander, J Chaloupka, Stanley L Barnwell, M E Mawad, Bethany F Lane, Michael J Lynn, Marc I ChimowitzAbstract:Background: The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial showed that patients with symptomatic 70% to 99% intracranial arterial stenosis are at particularly high risk of ipsilateral stroke on medical therapy: 18% at 1 year (95% CI = 3% to 24%). The Wingspan intracranial stent is another therapeutic option but there are limited data on the technical success of stenting and outcome of patients with 70% to 99% stenosis treated with a Wingspan stent. Methods: Sixteen medical centers enrolled consecutive patients treated with a Wingspan stent in this registry between November 2005 and October 2006. Data on stenting indication, severity of stenosis, technical success (stent placement across the target lesion with Results: A total of 129 patients with symptomatic 70% to 99% intracranial stenosis were enrolled. The technical success rate was 96.7%. The mean pre and post-stent stenoses were 82% and 20%. The frequency of any stroke, intracerebral hemorrhage, or death within 30 days or ipsilateral stroke beyond 30 days was 14.0% at 6 months (95% CI = 8.7% to 22.1%). The frequency of ≥50% restenosis on follow-up angiography was 13/52 (25%). Conclusion: The use of a Wingspan stent in patients with severe intracranial stenosis is relatively safe with high rate of technical success with moderately high rate of restenosis. Comparison of the event rates in high-risk patients in Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) vs this registry do not rule out either that stenting could be associated with a substantial relative risk reduction (e.g., 50%) or has no advantage compared with medical therapy. A randomized trial comparing stenting with medical therapy is needed. GLOSSARY: FDA = Food and Drug Administration; HDE = Humanitarian Device Exemption; ICH = intracerebral hemorrhage; WASID = Warfarin-Aspirin Symptomatic Intracranial Disease.
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the nih registry on use of the Wingspan stent for symptomatic 70 99 intracranial arterial stenosis
Neurology, 2008Co-Authors: Osama O. Zaidat, Helmi L. Lutsep, Richard P Klucznik, Michael J Alexander, J Chaloupka, Stanley L Barnwell, M E Mawad, Bethany F Lane, Michael J Lynn, Marc I ChimowitzAbstract:Background: The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial showed that patients with symptomatic 70% to 99% intracranial arterial stenosis are at particularly high risk of ipsilateral stroke on medical therapy: 18% at 1 year (95% CI = 3% to 24%). The Wingspan intracranial stent is another therapeutic option but there are limited data on the technical success of stenting and outcome of patients with 70% to 99% stenosis treated with a Wingspan stent. Methods: Sixteen medical centers enrolled consecutive patients treated with a Wingspan stent in this registry between November 2005 and October 2006. Data on stenting indication, severity of stenosis, technical success (stent placement across the target lesion with Results: A total of 129 patients with symptomatic 70% to 99% intracranial stenosis were enrolled. The technical success rate was 96.7%. The mean pre and post-stent stenoses were 82% and 20%. The frequency of any stroke, intracerebral hemorrhage, or death within 30 days or ipsilateral stroke beyond 30 days was 14.0% at 6 months (95% CI = 8.7% to 22.1%). The frequency of ≥50% restenosis on follow-up angiography was 13/52 (25%). Conclusion: The use of a Wingspan stent in patients with severe intracranial stenosis is relatively safe with high rate of technical success with moderately high rate of restenosis. Comparison of the event rates in high-risk patients in Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) vs this registry do not rule out either that stenting could be associated with a substantial relative risk reduction (e.g., 50%) or has no advantage compared with medical therapy. A randomized trial comparing stenting with medical therapy is needed. GLOSSARY: FDA = Food and Drug Administration; HDE = Humanitarian Device Exemption; ICH = intracerebral hemorrhage; WASID = Warfarin-Aspirin Symptomatic Intracranial Disease.
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Re: Turk et al and the "how do we spin Wingspan?" commentary.
AJNR. American journal of neuroradiology, 2008Co-Authors: Colin P. Derdeyn, Marc I ChimowitzAbstract:The article by Turk et al[1][1] is an important contribution to the literature regarding the endovascular management of symptomatic intracranial atherosclerotic disease (ICAD) in general and the use of the Wingspan stent (Boston Scientific, Natick, Mass) in particular. The authors reported
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The NIH registry on use of the Wingspan stent for symptomatic 70-99% intracranial arterial stenosis.
Neurology, 2008Co-Authors: Osama O. Zaidat, Helmi L. Lutsep, Richard P Klucznik, Michael J Alexander, J Chaloupka, Stanley L Barnwell, M E Mawad, Bethany F Lane, Michael J Lynn, Marc I ChimowitzAbstract:Background: The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial showed that patients with symptomatic 70% to 99% intracranial arterial stenosis are at particularly high risk of ipsilateral stroke on medical therapy: 18% at 1 year (95% CI = 3% to 24%). The Wingspan intracranial stent is another therapeutic option but there are limited data on the technical success of stenting and outcome of patients with 70% to 99% stenosis treated with a Wingspan stent. Methods: Sixteen medical centers enrolled consecutive patients treated with a Wingspan stent in this registry between November 2005 and October 2006. Data on stenting indication, severity of stenosis, technical success (stent placement across the target lesion with Results: A total of 129 patients with symptomatic 70% to 99% intracranial stenosis were enrolled. The technical success rate was 96.7%. The mean pre and post-stent stenoses were 82% and 20%. The frequency of any stroke, intracerebral hemorrhage, or death within 30 days or ipsilateral stroke beyond 30 days was 14.0% at 6 months (95% CI = 8.7% to 22.1%). The frequency of ≥50% restenosis on follow-up angiography was 13/52 (25%). Conclusion: The use of a Wingspan stent in patients with severe intracranial stenosis is relatively safe with high rate of technical success with moderately high rate of restenosis. Comparison of the event rates in high-risk patients in Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) vs this registry do not rule out either that stenting could be associated with a substantial relative risk reduction (e.g., 50%) or has no advantage compared with medical therapy. A randomized trial comparing stenting with medical therapy is needed. GLOSSARY: FDA = Food and Drug Administration; HDE = Humanitarian Device Exemption; ICH = intracerebral hemorrhage; WASID = Warfarin-Aspirin Symptomatic Intracranial Disease.
Shaye I. Moskowitz - One of the best experts on this subject based on the ideXlab platform.
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impact of wasid and Wingspan on the frequency of intracranial angioplasty and stenting at a high volume tertiary care hospital
Journal of NeuroInterventional Surgery, 2009Co-Authors: Shaye I. Moskowitz, Michael Kelly, Nancy A. Obuchowski, David FiorellaAbstract:Background and Purpose The impact of the Warfarin and Aspirin for Symptomatic Intracranial Disease (WASID) data is described in combination with the commercial release of the Wingspan stenting system on the frequency of neurointervention for the treatment of symptomatic intracranial atherosclerotic disease (ICAD) in a tertiary care center. Methods Endovascular case logs were reviewed from April 2004 to July 2007. The total number of intracranial neurointerventions and the number of neurointerventions (percutaneous transluminal angioplasty alone (PTA) or with stenting (PTAS)) performed for symptomatic ICAD were calculated. The time period evaluated was divided into two equal 19.5-month epochs representing the time periods before and after the availability of the Wingspan system. Results The frequency of neurointerventions for ICAD increased by 763%, from seven of 354 total cases (2%) to 56 of 367 total cases (15.3%) (p Conclusions The publication of the WASID trial results combined with the availability of the Wingspan stent system led to a marked increase in the frequency of neurointervention for symptomatic ICAD at our institution. The adoption of this technology occurred without direct evidence that PTAS with Wingspan is superior to traditional medical therapy. These findings underscore the need for a randomized trial of stenting and medical therapy for the treatment of this disease process.
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Impact of WASID and Wingspan on the frequency of intracranial angioplasty and stenting at a high volume tertiary care hospital.
Journal of neurointerventional surgery, 2009Co-Authors: Shaye I. Moskowitz, Michael Kelly, Nancy A. Obuchowski, David FiorellaAbstract:The impact of the Warfarin and Aspirin for Symptomatic Intracranial Disease (WASID) data is described in combination with the commercial release of the Wingspan stenting system on the frequency of neurointervention for the treatment of symptomatic intracranial atherosclerotic disease (ICAD) in a tertiary care center. Endovascular case logs were reviewed from April 2004 to July 2007. The total number of intracranial neurointerventions and the number of neurointerventions (percutaneous transluminal angioplasty alone (PTA) or with stenting (PTAS)) performed for symptomatic ICAD were calculated. The time period evaluated was divided into two equal 19.5-month epochs representing the time periods before and after the availability of the Wingspan system. The frequency of neurointerventions for ICAD increased by 763%, from seven of 354 total cases (2%) to 56 of 367 total cases (15.3%) (p<0.001) after the Wingspan system became available. The increase in intracranial PTAS volume occurred immediately and was stable throughout the "Wingspan era". The publication of the WASID trial results combined with the availability of the Wingspan stent system led to a marked increase in the frequency of neurointervention for symptomatic ICAD at our institution. The adoption of this technology occurred without direct evidence that PTAS with Wingspan is superior to traditional medical therapy. These findings underscore the need for a randomized trial of stenting and medical therapy for the treatment of this disease process.
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DynaCT evaluation of in-stent restenosis following Wingspan stenting of intracranial stenosis
Journal of neurointerventional surgery, 2009Co-Authors: Shaye I. Moskowitz, Michael Kelly, J Haynes, David FiorellaAbstract:Objective and importance To describe the use of DynaCT angiographic imaging for the evaluation of Wingspan in-stent restenosis (ISR). Methods Two patients were treated with Wingspan stenting and percutaneous transluminal angioplasty (Patient 1 had treatment of a severe stenosis of the right middle cerebral artery and patient 2 had severe stenosis of the left intracranial internal carotid artery. Both patients developed ISR and were evaluated with high resolution DynaCT angiographic imaging. Results DynaCT demonstrated circumferential soft tissue density material distributed within the stent as the cause of the stenosis visualized with conventional angiography. Conclusions These findings support the hypothesis that ISR is caused by neointimal proliferation, rather than vascular re-coil with stent collapse.
