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Brain Stent Could Cut Odds for a Second Stroke
  • Robert Preidt
  • Posted February 20, 2020

Brain Stent Could Cut Odds for a Second Stroke

For decades, artery-opening stents have helped prevent heart attacks, and new research suggests they might also help prevent strokes in the brain.

In a new study, the self-expanding, intracranial Wingspan brain stent seems effective over the long term in reducing stroke patients' risk of a subsequent stroke and death.

Intracranial stents are tiny mesh tubes that are permanently implanted to open clogged brain arteries and improve blood flow to the brain.

The new study looked at medical registry data on recurrent stroke or death in more than 150 stroke survivors who'd received a Wingspan brain stent.

The stent appeared to cut risks in half, said American Heart Association (AHA) president-elect Dr. Mitchell Elkind.

"After a year, there was a low risk of recurrent stroke or death in these patients compared to what we would expect historically," Elkind said. "So, about 9% or so of the patients had a recurrent event, compared with what we would expect to be closer to about 20%."

He stressed that this study wasn't a "gold-standard" randomized clinical trial. Still, "this is promising, and it suggests that for some patients, the benefits of stenting may be better than what we would expect if we treated them [in the traditional way]," according to Elkind, who is also professor of neurology and epidemiology at Columbia University in New York City.

One previous study found a 2.6% stroke and death rate within the first few days after patients received the Wingspan stent, but this new study looked at longer-term outcomes.

The new research relied on a database used in the prior, short-term study, and was led by Dr. Michael Alexander, professor and vice chairman of neurosurgery at Cedars-Sinai Medical Center, in Los Angeles.

The study tracked outcomes for 152 patients with narrowed arteries (atherosclerosis) treated at 16 U.S. centers. All were treated with the Wingspan stent, following U.S. Food and Drug Administration guidelines for its use.

The study was presented Thursday at the International Stroke Conference, in Los Angeles.

Results presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Nevertheless, "this is the largest intracranial stent trial for atherosclerotic disease performed according to the FDA indication for the Wingspan stent," Alexander noted in an association news release.

The results "are important to determine if safer stenting practices and lower complication rates from the treatment itself resulted in improved patient outcomes at one year," he said. According to Alexander, "intracranial stenting could provide an alternative when [drug] therapy and other treatments have been unsuccessful."

According to AHA president Elkind, the new findings could also "lead to future trials using [the] Wingspan stent or perhaps other stents. The technology is likely to continue to evolve."

He stressed that the patients in the new study were "highly selected," however, so it's too early to say whether a "broader group of patients" would reap the same benefit.

Dr. Andrew Rogove directs stroke services at Southside Hospital in Bay Shore, N.Y. Reading over the new findings, he agreed that more study is needed but, "if safe and effective, the use of intracranial stents could lower the rate of stroke in patients with severe atherosclerosis inside the arteries in the brain."

More information

The U.S. National Institute of Neurological Disorders and Stroke has more on stroke.

SOURCES: Andrew Rogove, M.D., Ph.D., medical director, stroke services, Southside Hospital, Bay Shore, N.Y.; Mitchell Elkind, M.D., president-elect, American Heart Association, and chair, advisory committee, American Stroke Association, and professor, neurology and epidemiology, Columbia University, New York City; American Stroke Association, news release, Feb. 20, 2020
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