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Hassan AE, Khalil M, Desai S, Tekle WG. Resolute onyx stent more effective than wingspan stent at preventing procedural complications and long-term restenosis. Interv Neuroradiol 2023; 29:691-695. [PMID: 35635224 PMCID: PMC10680955 DOI: 10.1177/15910199221104633] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Angioplasty and stenting is a treatment option for patients with medically refractory symptomatic intracranial atherosclerotic disease (sICAD). Currently the Wingspan Stent System (WSS) is the only FDA approved device for this indication. We find the Resolute (R) Onyx Stent, a drug-eluting balloon mounted stent (DES), a better alternative to the WSS for treatment of sICAD. Herein, we present our findings comparing the two stents based on our single center experience. METHODS A prospectively maintained neuro-endovascular databased was queried for patients between January 2013 to June 2021. Inclusion criteria for patients included sICAD with failed medical management, and intracranial stenting with either R-Onyx DES or WSS, including patients treated within 7 days of their last stroke. Primary outcomes were assessed via the occurrence of ischemic or hemorrhagic stroke or death within 72 h of the procedure. Secondary outcomes consisted of recurrent stroke or significant in-stent restenosis evaluated by a clinical or angiographic follow-up at 6 months. RESULTS A total of 184 patients, average age 61.26 (SD = 12.53) (44% women), were eligible for analysis with 58 having R-onyx DES and 126 having WSS. Within 72 h, the primary outcome was observed in 1.7% (n = 1) of patients in the R-onyx DES group and 6.3% (n = 8) of patients in the WSS group (p = 0.089). Among 41 angiographic and clinical follow-ups in the R-onyx DES group, none had a recurrent stroke, while among 101 patients who had follow-up in the WSS group, 8.9% (n = 9) had a stroke (p = 0.024). At a 6-month angiographic follow-up, there was a significantly lower rate of symptomatic in-stent restenosis among the R-onyx DES group with 1.7% (n = 1) compared with 21.4% (n = 27) in the WSS group (p = 0.0003). CONCLUSION R-onyx DES is more effective than WSS in treating sICAD with low rates of periprocedural complications and long-term strokes and symptomatic in-stent restenosis. Future prospective randomized multicenter trials are needed.
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Affiliation(s)
- Ameer E. Hassan
- University of Texas Rio Grande Valley, Edinburg, TX, USA
- Valley Baptist Medical Center, Harlingen, TX, USA
| | | | - Sohum Desai
- University of Texas Rio Grande Valley, Edinburg, TX, USA
- Valley Baptist Medical Center, Harlingen, TX, USA
| | - Wondwossen G. Tekle
- University of Texas Rio Grande Valley, Edinburg, TX, USA
- Valley Baptist Medical Center, Harlingen, TX, USA
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2
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El Koussa R, Graft J, Linder S, Bansal VK. Outcomes of Endovascular Stenting in Symptomatic Vertebral Artery Ostial Stenosis. Cureus 2022; 14:e21465. [PMID: 35223249 PMCID: PMC8858421 DOI: 10.7759/cureus.21465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/05/2022] Open
Abstract
Vertebral artery ostial stenosis is implicated in one-fifth of all posterior circulation cerebrovascular accidents. However, uniform treatment guidelines and data on the different treatment modalities are still lacking. Endovascular stenting is an emerging therapy for symptomatic vertebral artery ostial stenosis when medical management fails. This manuscript will examine the safety and efficacy of endovascular revascularization with drug-eluting stents in a series of ten consecutive patients that had failed medical management. We also report the rate of complications and in-stent restenosis, as well as the rate of recurrent cerebrovascular accidents.
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3
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Ma G, Song L, Ma N, Raynald, Shuai J, Wu W, Wan J, Zhao Z, Li G, Yin S, Ding S, Li J, Jia B, Tong X, Mo D, Gao F, Sun X, Deng Y, Huo X, Li W, Chen K, Miao Z. Safety and Efficacy of Rapamycin-Eluting Vertebral Stents in Patients With Symptomatic Extracranial Vertebral Artery Stenosis. Front Neurol 2021; 12:649426. [PMID: 34899552 PMCID: PMC8662782 DOI: 10.3389/fneur.2021.649426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 10/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background and Purpose: Drug-eluting stents generally have superior performance to bare metal stents in the treatment of vertebral artery stenosis (VAS). This prospective, multicenter, and single-arm clinical trial was initiated to assess in-stent restenosis (ISR) and midterm outcome after rapamycin-eluting stent placement in patients with symptomatic extracranial VAS. Methods: The subjects underwent angiographic follow-up at 6 months and final clinical follow-up at 12 months. The primary efficacy endpoint was ISR at 6 months. Secondary endpoints included technical success, target lesion-related transient ischemic attack (TIA), stroke, or death, and all-cause TIA, stroke, or death during the 12-month follow-up period. Results: A total of 104 stents were implanted in the 101 patients and 83 patients (82.2%) completed angiographic follow-up at 6 months. The technical success rate was 86.1% (87/101); mean in-stent stenosis rate was 25.1 ± 17.1% and ISR rate was 5.9% (95% CI: 0.8–10.9%). All the patients with ISR were completely asymptomatic and no stent fractures were observed during angiographic follow-up. At the 12-month clinical follow-up, target lesion-related TIA, stroke, or death had occurred in two (2.0%) patients and all-cause TIA, stroke, or death had occurred in six (6.1%) patients. Conclusion: The placement of rapamycin-eluting stents in patients with symptomatic extracranial VAS yields favorable ISR results and showed a trend of favorable safety outcomes including low rates of perioperative complications and late stroke. However, further study is needed to establish the long-term clinical benefits of this stent in the treatment of VA disease.
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Affiliation(s)
- Gaoting Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ligang Song
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Shuai
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Wei Wu
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhenwei Zhao
- Department of Neurosurgery, Institute for Functional Neurosurgery P.L.A, TangDu Hospital, Fourth Military Medical University, Xi'an, China
| | - Guangjian Li
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Sen Yin
- Department of Neurology, Qilu Hospital, Shandong University, Jinan, China
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiang Li
- Department of Neurosurgery, Institute for Functional Neurosurgery P.L.A, TangDu Hospital, Fourth Military Medical University, Xi'an, China
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuan Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yiming Deng
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kangning Chen
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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4
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Wang MY, Wang F, Liu YS, Yu LJ. Comparison of Drug-Coated Balloons to Bare Metal Stents in the Treatment of Symptomatic Vertebral Artery-Origin Stenosis: A Prospective Randomized Trial. World Neurosurg 2021; 154:e689-e697. [PMID: 34343687 DOI: 10.1016/j.wneu.2021.07.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to compare the angiographic and clinical outcomes of drug-coated balloon (DCB) with distal embolic protection devices (EPDs) versus bare metal stent (BMS) without EPD in the treatment of symptomatic vertebral artery origin stenosis (VAOS). METHODS Between January 2017 and December 2018, a prospective randomized trial was conducted involving 95 patients with symptomatic VAOS randomly assigned to treatment with DCB + EPD (n = 49) or BMS without EPD (n = 46). Target vessel restenosis (RS) >50% detected by computed tomography angiography was the primary endpoint. Technical success, clinical success, and signal intensity abnormalities on diffusion-weighted imaging within 3 days after operation were compared. RESULTS The 30-day technical success rate was 93.9% for DCB group versus 95.7% for the BMS group (P = 0.094). Diffusion-weighted imaging within 3 days postoperative showed asymptomatic embolization in 2 (4.1%) patients in the DCB group and 9 (19.6%) patients in the BMS group (P = 0.004). At a mean 16-month follow-up, the clinical success rate was 89.8% for the DCB group versus 91.3% (42/46) for the BMS group (P = 0.125). The RS was seen in 5/49 (10.2%) in the DCB group and 6/46 (13.0%) in the BMS group (P = 0.082). Target vessel revascularization was performed in 4 (8.7%) BMS group versus 3 (6.1%) in the DCB group (P = 0.091). CONCLUSIONS DCB with EPD in the treatment of symptomatic VAOS is technically feasible and safe and significantly reduced thromboembolic events on imaging when compared with BMS without EPD. There was no significant difference between the 2 groups in the rate of RS during 12 months after surgery.
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Affiliation(s)
- Ming-Yi Wang
- Department of Radiology, The Affiliated Tumour Hospital of Harbin Medical University, Harbin, China
| | - Feng Wang
- Department of Intervention Therapy, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yong-Sheng Liu
- Department of Intervention Therapy, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Li-Juan Yu
- Department of Radiology, The Affiliated Tumour Hospital of Harbin Medical University, Harbin, China.
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Li L, Wang X, Yang B, Wang Y, Gao P, Chen Y, Zhu F, Ma Y, Chi H, Zhang X, Bai X, Feng Y, Dmytriw AA, Hong T, Hua Y, Jiao L, Ling F. Validation and comparison of drug eluting stent to bare metal stent for restenosis rates following vertebral artery ostium stenting: A single-center real-world study. Interv Neuroradiol 2020; 26:629-636. [PMID: 32799746 DOI: 10.1177/1591019920949371] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE While drug-eluting stents (DES) have been widely applicated in coronary stenosis, uncertainty persists concerning the relative performance and clinical benefit in patients undergoing vertebral artery stenting when compared with a bare metal stent (BMS). We sought to compare in-stent restenosis (ISR) rates of DES and BMS in the treatment of vertebral artery ostium (VAO) stenosis. MATERIALS AND METHODS This study analyzed a single-center prospective cohort. Over 1.5-year period (January 2014-June 2015), 137 consecutive patients underwent VAO stenting involving deployment of 76 DES and 74 BMS. Patient demographics, comorbidities, stenosis severity, stent diameters and lengths, periprocedural complications, imaging and duplex ultrasonography follow-up and recurrent symptoms were assessed. RESULTS Technical success was achieved in all patients. Mean VAO stenosis at presentation were 82.4 ± 7.2% in the DES group and 83.3 ± 7.5% in the BMS group and were reduced to 12.5 ± 4.5% and 11.3 ± 4.0%. Mean stent diameter was 3.53 ± 0.40 mm in DES and 5.05 ± 0.40 mm in BMS (p < 0.0001). Mean follow-up was 12.3 months for DES and 11.7 months for BMS. The use of DES was associated with significant lower ISR rates compared with BMS (18.4% vs. 31.1%; OR = 2.628, p = 0.021). Recurrent symptoms rates were similar in DES vs. BMS (2.6% vs 2.7%, p = 0.680). Stent type and stent diameter were independent risk factors for ISR (P = 0.026). CONCLUSION Our results suggest superior efficacy of deploying DES for the treatment of VAO stenosis with lower ISR rates as compared to BMS, but do not support significant differences in periprocedural risk and recurrent symptoms rate.
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Affiliation(s)
- Long Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengshui Zhu
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haitao Chi
- Department of Neurology, Dalian University Affiliated Xinhua Hospital, Dalian, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Adam A Dmytriw
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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6
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Gruber P, Berberat J, Kahles T, Anon J, Diepers M, Nedeltchev K, Remonda L. Angioplasty Using Drug-Coated Balloons in Ostial Vertebral Artery Stenosis. Ann Vasc Surg 2019; 64:157-162. [PMID: 31639484 DOI: 10.1016/j.avsg.2019.10.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ostial vertebral artery stenosis (OVAS) is a relevant cause of acute ischemic posterior circulation stroke. Percutaneous trans-luminal angioplasty (PTA) might offer a promising treatment modality, but restenosis rate is high. So far, little is known about recanalization using drug-coated balloons (DCB) in OVAS. We aimed to show feasibility and safety of DCB-PTA in OVAS. METHODS Retrospective, monocenter case series of 12 patients with ostial vertebral artery stenosis (≥50%) treated with PTA using a drug-coated balloon. RESULTS Median age was 69.5 years (IQR 57-78.5) with a female rate of 41%. Patients were treated either with a SeQuent Please NEO or Neuro Elutax SV DEB. Median preinterventional stenosis degree was 75% (IQR 70-85) with a median lesion length of 4.5 mm (IQR 4-7.5). Median postinterventional stenosis degree was 40% (IQR 27-50). All treated vessels remained patent. No major complications such as dissection, vessel perforation, hemorrhage, or ischemic events occurred. Moreover, we did not detect any restenosis during a median follow-up period of 6.1 months. The clinical outcome was excellent with median mRS scale of 0 (IQR 0-1). CONCLUSIONS PTA using drug-coated balloons is feasible and safe in patients with ostial vertebral artery stenosis.
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Affiliation(s)
- Philipp Gruber
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland; Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
| | - Jatta Berberat
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Timo Kahles
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Javier Anon
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Michael Diepers
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland; University of Bern, Bern, Switzerland
| | - Luca Remonda
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland; University of Bern, Bern, Switzerland
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7
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Ortega-Gutierrez S, Lopez GV, Edgell RC, Mendez AA, Dandapat S, Roa JA, Zevallos CB, Holcombe AL, Hasan D, Derdeyn CP, Rossen J, Samaniego EA. Second Generation Drug-Eluting Stents for Endovascular Treatment of Ostial Vertebral Artery Stenosis: A Single Center Experience. Front Neurol 2019; 10:746. [PMID: 31379708 PMCID: PMC6646661 DOI: 10.3389/fneur.2019.00746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/26/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To report a single-center experience using drug-eluting balloon mounted stents (DES) for endovascular treatment of atherosclerotic ostial vertebral artery stenosis (OVAS). Background: Posterior circulation is affected in up to 25% of strokes, 20% of them resulting from atherosclerotic OVAS. The optimal management of symptomatic OVAS remains controversial. DES have been introduced to improve restenosis rates. Methods: We retrospectively analyzed prospectively collected data from patients with dominant OVAS who underwent endovascular treatment with second-generation DES placement. Patient demographics, clinical presentation, comorbidities, stenosis severity, stent features, technical success, complications, and imaging follow-up were assessed. Results: Thirty patients were treated, predominantly male (86.6%). Sixteen patients presented with an acute stroke or TIA and fourteen were treated on an elective basis due to symptomatic chronic stenosis and contralateral occlusion. Comorbidities included hyperlipidemia (83%), hypertension (70%) and prior stroke (63.3%). Mean ostial stenosis at presentation was 80 ± 14.8%. Twenty-one patients had contralateral VA involvement. DES deployment was technically successful in all patients using everolimus eluting stents in 30 lesions and zotarolimus eluting stents in two. One technical complication (stent migration) and three (10%) minor peri-procedural complications occurred. Complications included one asymptomatic ischemic infarct in the posterior circulation, one femoral artery thrombosis and one post-procedure altered mental status secondary to contrast induced neurotoxicity. Mean imaging follow-up was 8.8 months. Two (7.6%) patients had in-stent restenosis and underwent retreatment with angioplasty. There were no procedure-related mortalities. Conclusion: Our study confirms the feasibility of deploying DES for the treatment of ostial vertebral artery stenosis with low peri-procedural risk and low medium-term rates of re-stenosis.
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Affiliation(s)
- Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Gloria V Lopez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Randall C Edgell
- Department of Neurology, SSM Health Saint Louis University Hospital, St. Louis, MO, United States
| | - Aldo A Mendez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Jorge A Roa
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Cynthia B Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Andrea L Holcombe
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - David Hasan
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Colin P Derdeyn
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - James Rossen
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Internal Medicine - Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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8
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Risk Factors for Restenosis After Stenting or Angioplasty of Vertebral Artery Origin. Clin Neuroradiol 2019; 30:355-362. [DOI: 10.1007/s00062-019-00768-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
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9
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Tang X, Tang F, Hu C, Wang Q, Long W, Li L. Dynamic Respiratory Tortuosity of the Vertebral Artery Ostium. J Endovasc Ther 2016; 24:124-129. [PMID: 27831484 DOI: 10.1177/1526602816676254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the prevalence of dynamic respiratory tortuosity (DRT) of the vertebral artery ostium (VAO) as well as to evaluate its correlation with in-stent restenosis (ISR) and stent fracture. METHODS From March 2012 to June 2015, 178 consecutive patients (mean age 65.2±5.8 years; 124 men) with symptoms of atherosclerotic vertebrobasilar ischemia underwent angiography prior to stent implantation in the vertebral, subclavian, and/or carotid arteries. In this cohort, 54 patients (mean age 67.3±5.3 years; 40 men) had VAO stent implantation. Angiography of the vertebral artery was recorded in 2 phases with breath-hold: deep inspiration (DIP) and deep expiration (DEP). Obvious VAO tortuosity was defined as any VAO angle ≤120° in DIP. Obvious VAO-DRT was defined as any VAO angle increasing ≥60° from DIP to DEP. Computed tomography angiography (CTA) or digital subtraction angiography was used in follow-up to detect ISR and stent fracture. RESULTS Of the 178 patients in this study, 21 (11.8%) had obvious VAO tortuosity and 8 (4.5%) had obvious VAO-DRT. Two of the 21 patients with obvious VAO tortuosity also had obvious VAO-DRT. Three of the 54 VAO stent patients had VAO-DRT. There were no correlations between VAO-DRT and age, sex, risk factors, body mass index, chronic obstructive pulmonary disease, asthma, or obvious VAO tortuosity (p>0.05). Over a mean follow-up of 28±10 months, there were 4 (7.4%) asymptomatic VAO ISR cases. Two (3.7%) were occlusions at 6 and 12 months, respectively; both were associated with stent fracture in patients with obvious VAO-DRT before stenting. Both stents fractured at the tortuous VAO region. VAO-DRT was correlated with stent fracture (Spearman ρ=0.81, p<0.01) and ISR (Spearman ρ=0.55, p<0.01). CONCLUSION VAO-DRT could be a risk factor for stent fracture and restenosis after VAO stent implantation. Angiography in both inspiration and expiration phases, especially the latter, should be considered before VAO stenting. Using a shorter stent to avoid crossing the tortuosity could reduce the occurrence of fracture.
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Affiliation(s)
- Xiaobin Tang
- 1 Vascular Surgery Department, Beijing Anzhen Hospital, Beijing, China
| | - Feng Tang
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Chang Hu
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Qian Wang
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Whitney Long
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Lei Li
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
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10
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Babic S, Radak D. Letter to the Editor: Surgical treatment of VA stenosis in the endovascular era. J Neurosurg 2015; 123:1611. [PMID: 26430842 DOI: 10.3171/2015.4.jns15360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Srdjan Babic
- Institute for Cardiovascular Disease "Dedinje," Belgrade, Serbia; and Belgrade University School of Medicine, Belgrade, Serbia
| | - Djordje Radak
- Institute for Cardiovascular Disease "Dedinje," Belgrade, Serbia; and Belgrade University School of Medicine, Belgrade, Serbia
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11
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12
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Geng X, Hussain M, Du H, Zhao L, Chen J, Su W, Ma L, Gao Z, Ding Y, Ji X. Comparison of self-expanding stents with distal embolic protection to balloon-expandable stents without a protection device in the treatment of symptomatic vertebral artery origin stenosis: a prospective randomized trial. J Endovasc Ther 2015; 22:436-44. [PMID: 25862360 DOI: 10.1177/1526602815579406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the angiographic and clinical outcomes of self-expanding stents (SES) with distal embolic protection devices (EPD) vs balloon-expandable stents (BES) without EPD in the treatment of symptomatic atherosclerotic vertebral artery ostial stenosis (VAOS). METHODS Between July 2011 and March 2013, a prospective randomized trial was conducted involving 127 patients (mean age 67.3±10.2 years; 94 men) with symptomatic VAOS randomly assigned to treatment with SES + EPD (Precise RX or RX Acculink stent + Spider FX EPD; n=61) or BES (Palmaz Blue or Resolute RX; n=66) without EPD. In-stent restenosis (ISR) >50% detected by duplex ultrasound was the primary endpoint. Technical success, clinical success, complications within 30 days, and signal intensity abnormalities on diffusion weighted imaging (DWI) after stenting were compared. RESULTS The 30-day technical success rate was 95.5% (63/66) for SES+EPD vs 100% (70/70) for BES without EPD (p=0.072). DWI at 24 hours poststenting showed 2 hyperintense lesions in 2 (3.3%) SES + EPD cases and 15 hyperintense lesions in 13 (18.6%) BES patients (p<0.01). At a mean 18-month follow-up, the clinical success rate was 93.9% (62/66) for the SES + EPD group vs 85.7% (60/70) for the BES group (p=0.115). The ISR was seen in 16/70 (22.9%) arteries in the BES group and 2/66 (3.1%) arteries in SES + EPD group (p<0.01). Target vessel revascularization was performed in 7 (10.0%) BES arteries vs none in the SES + EPD group (p<0.01). CONCLUSION SES with EPD in the treatment of symptomatic VAOS is technically feasible and safe, with low rates of ISR and significantly reduced thromboembolic events on imaging when compared to BES without EPD.
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Affiliation(s)
- Xiaokun Geng
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mohammed Hussain
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Huishan Du
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China
| | - Liang Zhao
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Vascular Surgery, Luhe Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Su
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linlin Ma
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China
| | - Zongen Gao
- Department of Neurology, Central Hospital of Shengli Oilfield, Dongying, China
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Rangel-Castilla L, Gandhi S, Munich SA, Cress MC, Sonig A, Krishna C, Hopkins LN, Snyder KV, Levy EI, Siddiqui AH. Experience with vertebral artery origin stenting and ostium dilatation: results of treatment and clinical outcomes. J Neurointerv Surg 2015; 8:476-80. [DOI: 10.1136/neurintsurg-2015-011655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/15/2015] [Indexed: 12/20/2022]
Abstract
BackgroundThe vertebral artery (VA) ostium (VAO) is a common stenosis site. Most patients with VAO stenosis refractory to medical treatment are treated endovascularly using stenting. To optimally cover the ostial plaque, which frequently extends into the adjacent subclavian artery, part of the stent must overhang in the subclavian artery. This configuration makes subsequent VA access very challenging in cases of in-stent or distal vertebrobasilar pathology; it also obstructs the distal subclavian artery.ObjectiveTo determine whether angioplasty at the ostium with a dual balloon (Flash Ostial) specially designed to allow the subclavian end of the stent to flare might circumvent these problems and, most importantly, provide optimal plaque coverage around the vertebral ostium.MethodsBetween June 2012 and July 2014, 11 patients with symptomatic VAO stenosis refractory to best medical therapy were treated with stenting and dual balloon Flash angioplasty. Demographics, results, and outcomes were reviewed.ResultsA total of 12 VAO stenting–dual balloon angioplasty procedures were performed (mean stenosis, 83.6%; range, 78–90%). Nine patients had mild-to-moderate (40–60%) contralateral VAO stenosis. The initial average modified Rankin Scale (mRS) score was 1.25. In all cases, immediate postangioplasty angiography showed excellent stent apposition against the VA and around the ostium in the subclavian artery. No permanent perioperative complications or deaths occurred. At a mean follow-up of 10.8 months (range 2–24), all patients had symptom resolution and no evidence of symptomatic restenosis on neuroimaging/Doppler studies; the average mRS score was 0.66. Three patients continued to have previously diagnosed mid-cervical VA stenosis; one of them had postprocedure dissection and an asymptomatic in-stent stenosis at 8 months.ConclusionsSafety and feasibility were demonstrated using the Ostial Flash system for VAO stenting and angioplasty. No permanent perioperative complications were seen.
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14
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Rangel-Castilla L, Kalani MYS, Cronk K, Zabramski JM, Russin JJ, Spetzler RF. Vertebral artery transposition for revascularization of the posterior circulation: a critical assessment of temporary and permanent complications and outcomes. J Neurosurg 2014; 122:671-7. [PMID: 25397367 DOI: 10.3171/2014.9.jns14194] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Despite advances in medical management and endovascular therapies, including the introduction of statins, antiplatelet agents, and drug-eluting stents, some patients experience medically refractory vertebrobasilar insufficiency and may benefit from robust surgical revascularization. The aim of this study was to evaluate such patients after surgical revascularization, emphasizing long-term outcomes and rates of complications. METHODS The authors retrospectively identified 22 patients (5 women and 17 men) whose mean age was 69.1 years (range 48-81 years) who underwent revascularization of the posterior circulation via a proximal vertebral artery-carotid artery transposition between 2005 and 2013. The patients' conditions before surgery were clinically summarized, and long-term outcomes and complication rates after surgery were evaluated. RESULTS All the patients were symptomatic before surgery although they received the best medical therapy as defined by their primary care physician. Presenting symptoms consisted of stroke, transient ischemic attacks (TIAs), and/or findings attributable to posterior circulation hypoperfusion. There were no deaths associated with revascularization surgery. The postoperative complication rate was 45.5%, which included 3 cases of recurrent laryngeal nerve palsy, 1 case of thoracic duct injury, 2 cases of TIA, and 4 cases of Horner's syndrome. The thoracic duct injury was identified intraoperatively and ligated without sequelae, all the TIAs resolved within 24 hours of surgery, all 4 sympathetic plexus injuries resolved, and all but 1 of the recurrent laryngeal nerve palsies resolved, resulting in a 4.5% complication rate in a mean follow-up period of 8.8 months. All the patients had resolution of their presenting symptoms, and a single patient had symptomatic restenosis that required stenting and angioplasty, resulting in a restenosis rate of 4.5%. CONCLUSIONS Despite the optimization of medical therapies and lifestyle modifications, a select subset of patients with posterior vascular circulation insufficiency remains. In the authors' experience, vertebral artery-carotid artery transposition provides a surgical option with relatively low long-term complication and restenosis rates that are comparable or lower than those reported with endovascular treatment.
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Affiliation(s)
- Leonardo Rangel-Castilla
- Division of Neurological Surgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, Arizona
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15
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Brasiliense LBC, Albuquerque FC, Spetzler RF, Hanel RA. Advances and Innovations in Revascularization of Extracranial Vertebral Artery. Neurosurgery 2014; 74 Suppl 1:S102-15. [DOI: 10.1227/neu.0000000000000218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Revascularization of the extracranial vertebral artery has evolved significantly since the adoption of endovascular techniques. The current neurosurgical armamentarium includes microsurgical and endovascular approaches. The indications for each treatment modality, however, still need to be further delineated. In contrast to carotid artery endarterectomy and carotid artery angioplasty/stenting, there is limited comparative evidence on the efficacy of medical, open, and endovascular treatment of atherosclerotic disease of the extracranial vertebral artery. More recently, drug-eluting stents have gained momentum after high rates of in-stent restenosis have been reported with bare metal stents placed in the vertebral artery. In this article, we discuss the indications, clinical assessment, and surgical nuances of microsurgical and endovascular revascularization for atherosclerotic disease of the extracranial vertebral artery. Despite a general tendency to consider endovascular treatment in the majority of patients, ultimately, open and endovascular revascularization of extracranial vertebral artery should be regarded as complementary therapies and both treatment options need to be discussed in selected patients.
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Affiliation(s)
| | - Felipe C. Albuquerque
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F. Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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16
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Li Z, Zhang Y, Hong B, Deng B, Xu Y, Zhao W, Liu J, Huang Q. Stenting of symptomatic vertebral artery ostium stenosis with self-expanding stents. J Clin Neurosci 2014; 21:274-7. [DOI: 10.1016/j.jocn.2013.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
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17
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Lu H, Zheng P, Zhang W. Long-term outcome of drug-eluting stenting for stenoses of the intracranial vertebrobasilar artery and vertebral ostium. J Neurointerv Surg 2012; 5:435-9. [DOI: 10.1136/neurintsurg-2012-010367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Song L, Li J, Gu Y, Yu H, Chen B, Guo L, Zhang J. Drug-Eluting vs. Bare Metal Stents for Symptomatic Vertebral Artery Stenosis. J Endovasc Ther 2012; 19:231-8. [DOI: 10.1583/11-3718.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Antoniou GA, Murray D, Georgiadis GS, Antoniou SA, Schiro A, Serracino-Inglott F, Smyth JV. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg 2011; 55:1167-77. [PMID: 22206680 DOI: 10.1016/j.jvs.2011.09.084] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 09/06/2011] [Accepted: 09/24/2011] [Indexed: 01/23/2023]
Abstract
BACKGROUND Atherosclerotic occlusive disease of the proximal vertebral artery is an important cause of cerebrovascular ischemic events with a significant associated morbidity and mortality. Endovascular treatment has emerged as a promising tool of the therapeutic armamentarium, along with medical therapy and surgical reconstruction. Our objective was to systemically review the pertinent evidence on the endovascular management of proximal vertebral artery disease and perform an analysis of the published outcomes. METHODS A systematic review of the literature identified all studies reporting percutaneous transluminal angioplasty or stenting, or both, for proximal vertebral artery stenosis. Web-based search engines were searched using the Medical Subject Headings terms "vertebral artery," "angioplasty," and "stents" in all possible combinations. Studies comprising a series of at least five patients were considered for analysis. Periprocedural transient ischemic attack and stroke and death from any cause ≤30 days of treatment were defined as the primary outcome end points. RESULTS One randomized controlled trial comparing angioplasty and stenting of the proximal vertebral artery and medical therapy was identified. No comparative studies of endovascular treatment and open surgical repair were found. Forty-two selected studies reported endovascular treatment (angioplasty or stenting, or both) of 1117 vertebral arteries in 1099 patients. The weighted mean technical success rate was 97% (range, 36%-100%). Periprocedural transient ischemic attack occurred in 17 patients (1.5%). The combined stroke and death rate was 1.1%. Recurrent symptoms of vertebrobasilar insufficiency developed in 65 of 967 patients (8%) within a reported follow-up of 6 to 54 months. Restenosis developed in 183 of 789 patients (23%) who underwent follow-up imaging (range, 0%-58%). Reintervention for recurrent disease during follow-up occurred in 86 patients (9%; range, 0%-35%). CONCLUSIONS There is limited comparative evidence on the efficacy of medical, surgical, and endovascular treatment of proximal vertebral artery disease. Percutaneous transluminal angioplasty and stenting has low periprocedural neurologic adverse events and mortality.
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Affiliation(s)
- George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
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Yavagal DR, Haussen DC. Large Artery Revascularization. Continuum (Minneap Minn) 2011; 17:1267-92. [DOI: 10.1212/01.con.0000410035.26853.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Stayman AN, Nogueira RG, Gupta R. A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis. Stroke 2011; 42:2212-6. [DOI: 10.1161/strokeaha.110.611459] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Aaron N. Stayman
- From the Department of Neurology (A.N.S.), Vanderbilt University School of Medicine, Nashville, TN; Departments of Neurology (R.G.N., R.G.), Neurosurgery and Radiology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA
| | - Raul G. Nogueira
- From the Department of Neurology (A.N.S.), Vanderbilt University School of Medicine, Nashville, TN; Departments of Neurology (R.G.N., R.G.), Neurosurgery and Radiology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA
| | - Rishi Gupta
- From the Department of Neurology (A.N.S.), Vanderbilt University School of Medicine, Nashville, TN; Departments of Neurology (R.G.N., R.G.), Neurosurgery and Radiology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA
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Fields JD, Petersen BD, Lutsep HL, Nesbit GM, Liu KC, Dogan A, Lee DS, Clark WM, Barnwell SL. Drug eluting stents for symptomatic intracranial and vertebral artery stenosis. Interv Neuroradiol 2011; 17:241-7. [PMID: 21696666 DOI: 10.1177/159101991101700217] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 04/17/2011] [Indexed: 11/15/2022] Open
Abstract
The use of bare metal stents (BMS) to prevent recurrent stroke due to stenosis of the cerebral vasculature is associated with high rates of restenosis. Drug-eluting stents (DES) may decrease this risk. We evaluated the performance of DES in a cohort of patients treated at our institution.Consecutive patients treated with DES were identified by a case log and billing records; data regarding procedural details, clinical outcome and angiographic follow-up was obtained by retrospective chart review.Twenty-six patients (27 vessels; 14 vertebral origin (VO); 13 intracranial) were treated. Stenosis was reduced from mean 81% to 8% at the VO and 80% to 2% intracranially. No strokes occurred in the first 24 hours after stenting or at any time point in the VO group during a mean follow-up period of nine months. Among patients with intracranial stents, stroke with permanent disability occurred within 30 days in 1/12 (8%) and after 30 days in 1/11 (9%) with clinical follow-up (mean follow-up, 14 months). Follow-up catheter angiography was obtained in 14/14 (100%) in the VO group at mean eight months and in 8/11 surviving patients (73%) at a mean of ten months after stenting in the intracranial group. The restenosis rate was 21% at the VO (3/14) and 38% (3/8) for intracranial stents. Restenosis at the VO was less frequent than might have been expected from reports utilizing BMS, however, overall restenosis rates appeared higher than previously reported for patients with intracranial DES and comparable with restenosis rates for intracranial BMS.
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Affiliation(s)
- J D Fields
- Interventional Neuroradiology, Department of Neurology Oregon Health & Science University, Portland, USA.
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