Clinical experience in intracranial stenting of Wingspan stent system under local anesthesia

Mao-Shih Lin; Chih-Wei Huang; Yuang-Seng Tsuei

doi:10.3389/fneur.2024.1348779

Clinical experience in intracranial stenting of Wingspan stent system under local anesthesia

Front Neurol. 2024 Mar 22:15:1348779. doi: 10.3389/fneur.2024.1348779. eCollection 2024.

Authors

Mao-Shih Lin^#¹, Chih-Wei Huang^#^{1

2}, Yuang-Seng Tsuei^{1

2

3

4}

Affiliations

¹ Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan.
² Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
³ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁴ Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan.

^# Contributed equally.

Abstract

Objective: The use of endovascular treatments for symptomatic intracranial atherosclerosis disease (ICAD) remains contentious due to high periprocedural complications. Many centers resort to general anesthesia for airway protection and optimal periprocedural conditions; however, this approach lacks real-time monitoring of patients' neurological status during procedures. In this study, we employed intracranial stenting with the Wingspan system under local anesthesia to address this challenge.

Methods: We conducted a retrospective study of 45 consecutive ICAD patients who underwent intracranial stenting with the Wingspan system at our hospital from August 2013 to May 2021. These stenting procedures were performed under local anesthesia in a hybrid operation room. Neurological assessments were conducted during the procedure. The patients with periprocedural complications were analyzed for the risk factors.

Results: The study included 45 ICAD patients (median age 62 years; 35 male and 10 female individuals). Among them, 30 patients had anterior circulation ICAD, and 15 had posterior circulation ICAD. The periprocedural complication rate was 8.9% (4/45), with an overall mortality rate of 2.2% (1/45). Notably, no procedure-related perforation complications were found, and all ischemic complications occurred in the perforating bearing artery, specifically in patients with stents placed in the middle cerebral artery or basilar artery, while no complications were observed in the non-perforating bearing artery of the internal carotid artery and vertebral artery (p = 0.04).

Conclusion: Our study demonstrates the safety and efficacy of the Wingspan stent system when performed on selected patients under local anesthesia. This approach seems to reduce procedural-related morbidity and be a safe intervention. In addition, it is crucial for surgeons to be aware that patients with perforator-bearing artery stenosis may be at a higher risk of complications.

Keywords: Wingspan; angioplasty; intracranial atherosclerosis disease; intracranial stent; local anesthesia.

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.