DynaCT evaluation of in-stent restenosis following Wingspan stenting of intracranial stenosis

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.