Angioplasty and Stenting of Symptomatic Vertebral Artery Stenosis Clinical and Angiographic Follow-up of 206 Cases from Northwest Iran

Mohammadian, Reza; Sharifipour, Ehsan; Mansourizadeh, Reza; Sohrabi, Bahram; Nayebi, A.R.; Haririan, Sajad; Farhoudi, Mehdi; Charsouei, Saeid; Najmi, Safa

doi:10.1177/197140091302600410

Cited by 22 publications

(16 citation statements)

References 36 publications

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“…The use of EPDs has been described in several studies involving angioplasty and stenting of lesions of a VA origin [1,5,7,9,10,12,13,14]. To date, newer or alternative methods for cerebral protection for the treatment of vertebrobasilar (VB) stenosis have not yet been elucidated.…”

Section: Introductionmentioning

confidence: 99%

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The Use of Aspiration Catheter Systems for Embolic Protection during Intracranial Vertebral Artery Angioplasty and Stenting

2015

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Background: Posterior circulation strokes comprise approximately 20-25% of all strokes of ischemic origin. Strokes affecting this area carry a significantly higher risk for subsequent stroke or death as compared to anterior circulation strokes. Embolic protection device (EPD) use for carotid artery stenosis has translated into percutaneous interventions of proximal vertebral artery (VA) stenosis. However, the use of EPDs when treating intracranial lesions has yet to be studied and may not be feasible as the vessel caliber is frequently smaller than in existing devices. Objective: The aim of this study is to describe a proximal aspiration technique used during the treatment of intracranial VA and basilar artery (BA) atherosclerotic disease. Methods: Proximal embolic protection was utilized during the treatment of intracranial VA/BA stenosis with angioplasty and stenting in patients with medically refractory disease. Results: Three patients with severe symptomatic posterior circulation stenosis refractory to medical management were treated with angioplasty and stenting utilizing proximal aspiration. Pre- and post-treatment angiograms and MRIs were compared. Treated vascular stenoses were significantly improved, without new neurological deficits or ischemic injury identified on imaging. Conclusions: The proposed technique of proximal embolic protection may help overcome the challenge of embolus propagation inherent to the treatment modality that was encountered during the treatment of intracranial VA/BA stenosis.

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Section: Introductionmentioning

confidence: 99%

“…Atherosclerotic disease is a major cause of ischemic events worldwide [1,2,3]. Posterior circulation strokes comprise approximately 20-25% of all strokes of ischemic origin.…”

Section: Introductionmentioning

confidence: 99%

The Use of Aspiration Catheter Systems for Embolic Protection during Intracranial Vertebral Artery Angioplasty and Stenting

2015

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“…Mohammadian et al (2013) reported a 15.9% restenosis rate in a 2-y series of 206 patients who underwent percutaneous trans-luminal angioplasty or stenting to treat VA stenosis in all segments (V1-V4). This result is similar to that in the present study.…”

Section: Discussionmentioning

confidence: 98%

Evaluation of Interventional Therapy for Patients with Intracranial Vertebral Artery Stenosis by Transcranial Color-Coded Sonography

Zhou

Yang

et al. 2016

Ultrasound in Medicine & Biology

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“…In our study all lesions were treated with stents as primary stenting has been shown to improve long-term patency compared with balloon procedures alone [ 11 , 12 ]. Despite higher rates of restenosis as compared to other treatment options, balloon angioplasty may be considered in patients who are unable to tolerate open surgery and/or with contraindications to dual-antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous vertebral and subclavian artery stenting

Maciejewski¹,

Tekieli²,

Machnik³

et al. 2017

pwki

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IntroductionVertebrobasilar territory ischemia leads to disabling neurological symptoms and may be caused both by vertebral artery (VA) and subclavian artery (SA) stenosis. The coexisting symptomatic ipsilateral VA and proximal SA stenosis should be considered as a true bifurcation lesion for percutaneous treatment.AimTo evaluate the safety and efficacy of simultaneous angioplasty of vertebral and subclavian stenosis.Material and methodsFifteen patients (age 69.5 years, 46.7% men, all symptomatic from posterior circulation (history of stroke, transient ischemic attack, chronic ischemia symptoms)) were scheduled for simultaneous SA/VA angioplasty. Clinical and duplex ultrasound follow-up was conducted 1, 6 and 12 months after the procedure.ResultsThe technical success rate was 100%. Single balloon-mounted stent angioplasty was performed for all VAs and for 13 (86.7%) SAs. In 4 cases a simultaneous radial and femoral approach was required. The mean North American Symptomatic Carotid Endarterectomy Trial (NASCET) VA stenosis was reduced from 88.7 ±9.7% to 5.7 ±6.8% and SA stenosis from 80 ±12.2% to 11 ±12.3% (p < 0.01). No periprocedural death, stroke, myocardial infarction or transient ischemic attack occurred. During follow-up (range: 6–107 months) in 10 of 15 (66.7%) patients relief of chronic ischemic symptoms was observed. No stroke/TIA occurred. One cardiovascular and 2 non-cardiovascular deaths were recorded. There was 1 symptomatic vertebral and 1 subclavian in-stent restenosis, and 2 cases of asymptomatic VA in-stent occlusion occurred.ConclusionsSimultaneous vertebral and subclavian artery stenting is safe and effective. The restenosis rate remains at an acceptable level and it may be treated successfully with drug-eluting balloon angioplasty. In selected patients a dual radial and femoral approach may facilitate the procedure.

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Angioplasty and Stenting of Symptomatic Vertebral Artery Stenosis Clinical and Angiographic Follow-up of 206 Cases from Northwest Iran

Abstract: SUMMARY -Percutaneous transluminal angioplasty (PTA) has recently become a noteworthy treatment option for significant stenosis involving the vertebral artery (VA)

Cited by 22 publications

References 36 publications

The Use of Aspiration Catheter Systems for Embolic Protection during Intracranial Vertebral Artery Angioplasty and Stenting

The Use of Aspiration Catheter Systems for Embolic Protection during Intracranial Vertebral Artery Angioplasty and Stenting

Evaluation of Interventional Therapy for Patients with Intracranial Vertebral Artery Stenosis by Transcranial Color-Coded Sonography

Simultaneous vertebral and subclavian artery stenting

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