Use of the Szabo Technique to Guide Accurate Stent Placement at the Vertebral Artery Ostium

Ostial lesion of the anterior descending coronary artery treated via Szabo technique supported by stent boost imaging: a case report

Background

Stenosis at the opening and bifurcation of the anterior descending branch and circumflex branch around the end of the left main trunk is difficult to repair. Accurate positioning of a stent is the key problem.

Case presentations

Here we report the case of a 61-year-old man who suffered from paroxysmal chest pain for 1 year, without history of diabetes or hypertension. The coronary computed tomography showed mixed plaques in the proximal part of the anterior descending artery, with stenosis severe at 80–90%. The emergency coronary angiography showed occlusion of the anterior descending artery. During percutaneous coronary intervention, a drug-eluting stent was implanted into the anterior descending artery using the Szabo technique, supported by stent boost (StentBoost) imaging to pinpoint the location of the lesion. The patient’s paroxysmal chest pain was relieved after the procedure.

Conclusion

We used StentBoost to verify the accuracy of stent placement and the Szabo technique to rectify long-term coronary stenosis, which achieved satisfactory results. Combining the Szabo technique with StentBoost imaging was helpful to accurately evaluate the area and locate the stent when treating this ostial lesion of the anterior descending coronary artery.

Vertebral artery stenosis

Symptomatic vertebral artery stenosis is associated with high risk of early recurrent stroke. Vertebral artery stenosis can be treated with angioplasty and stenting with good technical results. In this review we outline the framework for the diagnosis and management of vertebral artery disease with focus on the emerging benefits of angiography and endovascular interventions.

Endovascular treatment of patient with multiple extracranial large vessel stenosis and coexistent unruptured wide-neck intracranial aneurysm using a WEB device and Szabo-technique

The coexistence of severe extracranial large vessel stenosis and unruptured intracranial aneurysms is not rare. There are different treatment approaches for these conditions, such as initial treatment of the aneurysm before revascularization of the stenosis; single-stage endovascular treatment of both lesions; stenosis eliminating followed by treatment of the aneurysm, or without treating the aneurysm. But, taking into account the risk of aneurysm rupture on the one hand and the risk of ischemic stroke on the other, it is sometimes difficult to choose the right management strategy. Despite this fact, there are still no guidelines or consensus on the management of these coexistent lesions. The article describes a clinical case of endovascular treatment of multiple extracranial stenosis and coexistent unruptured wide-neck aneurysm of the middle cerebral artery. The endovascular treatment of the carotid stenosis and aneurysm using a woven endobridge device was performed in one session; endovascular treatment of vertebral artery stenosis with Szabo technique was performed in another session.

Clinical outcomes and influencing factors of in-stent restenosis after stenting for symptomatic stenosis of the vertebral V1 segment

OBJECTIVE

The objective of this study was to evaluate 30-day and long-term clinical outcomes and influencing factors of in-stent restenosis (ISR) after stenting for symptomatic stenosis of the vertebral V1 segment.

METHODS

The clinical and follow-up data of 301 consecutive patients (mean age, 64 ± 8 years; 252 men) with symptomatic V1 stenosis who underwent stenting at the Fuwai Hospital between January 2010 and June 2016 were collected retrospectively. The 30-day and long-term follow-up of stroke and death after stenting and the recurrence of symptoms, ISR, and repeated revascularization were assessed.

RESULTS

Technical success was 100%. The mean stenosis of lesions was reduced from 82.8% ± 7.6% to 4.4% ± 4.0% immediately after 312 stents (165 bare-metal stents [BMSs] and 147 drug-eluting stents) were implanted. The overall risk of combined any stroke and death was 1.0% (3/301) within 30 days after stenting. The rates of freedom from any stroke and death were 98.2%, 96.8%, and 91.4% at 1 year, 3 years, and 5 years, respectively. After a mean follow-up of 2.9 ± 1.5 years, 46 (15.8%) patients developed ISR, of whom 19 (6.5%) were symptomatic. Twenty-two (7.6%) patients with ISR underwent repeated revascularization. The primary and assisted patency rates were 90.0% and 95.4%, 82.6% and 90.3%, and 80.3% and 87.9% at 1 year, 3 years, and 5 years, respectively. BMS (hazard ratio, 2.02; 95% confidence interval, 1.01-4.06; P < .05) and diabetes (hazard ratio, 1.87; 95% confidence interval, 1.04-3.37; P = .04) were independently associated with an increased risk of ISR.

CONCLUSIONS

Percutaneous stent placement for symptomatic V1 stenosis is safe and associated with a good long-term patency rate. BMS and diabetes are independent predictive factors of ISR.

Successful Treatment of a Subclavian Artery Stenosis With a Coronary Bioresorbable Vascular Scaffold

PURPOSE

To report the use of a coronary bioresorbable vascular scaffold to treat subclavian artery disease.

CASE REPORT

A 58-year-old man was admitted for left subclavian steal syndrome. Angiography showed significant left subclavian stenosis in proximity to the ostium of the left vertebral artery. To maximize radial support and minimize restenosis risk while avoiding the chance of vertebral compromise, a coronary bioresorbable vascular scaffold (3.5×28 mm) was implanted after predilation. The device was postdilated with a 1.0-mm oversized balloon, with immediate improvement in hemodynamics and symptoms. Two-year clinical and imaging follow-up confirmed vessel patency.

CONCLUSION

This clinical vignette highlights the flexibility and potential of bioresorbable devices for endovascular specialists and calls for further development and use of this innovative technology.