Intracranial Stent Opens Cerebral Blockages

The Wingspan stent system, developed by Boston Scientific (Natick, MA, USA) and designed for use in patients with intracranial atherosclerotic disease, is an extra-flexible, self-expanding stent designed to promote vessel wall apposition in curved and tapered vessels. The stent, composed of nitinol, an alloy of nickel and titanium, features a flexible cell design for enhanced conformability and to facilitate access, especially with longer stent lengths. It is used in conjunction with Boston Scientific's Gateway percutaneous transluminal angioplasty (TPA) balloon catheter, a semi-compliant balloon designed for controlled, low-pressure inflation.

The self-expanding stent is snaked in a catheter through the femoral artery and into the blood vessel in question. With the aid of x-rays, the surgeon navigates the stent device into the cerebral circulation to the precise location of the narrowing and blockage. The stent system is inserted through the blockage, and the balloon catheter is then inflated with low pressure to provide pre-dilation prior to stent deployment. The balloon and catheter are removed, and the stent is released from the second catheter. The procedure can last from 30 minutes to two hours, depending on the complexity of the case, and patients may leave the hospital as soon as 48 hours later. Recovery time is dictated by the patient's neurologic condition.

Previously, patients had few options to avoid strokes, usually involving anticoagulants such as Coumadin, Plavix, and aspirin. However, blood-thinning drugs fail to open blockages in brain arteries in 30% of cases, and many of those patients who initially respond to such medications often go on to have another stroke in the next year.

"It's the first self-expanding stent for intracranial use designed specifically for atherosclerotic disease in the brain,” said Robert Rosenwasser, M.D., chair of neurosurgery at Thomas Jefferson University Hospital (Philadelphia, PA, USA). "The device will allow us to treat more patients up front before they exhaust medical therapy.”

Intracranial atherosclerotic disease results from too much plaque in brain arteries. The condition accounts for about 8-10% of strokes due to ischemia, or lack of oxygen to the brain.



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