Drug-Eluting Stents for the Treatment of Vertebral Artery Origin Stenosis

Werner, Martin; Bräunlich, Sven; Ülrich, Matthias; Bausback, Yvonne; Schuster, Johannes; Lukhaup, Anina; Botsios, Spiridon; Scheinert, Dierk; Schmidt, Andrej

doi:10.1583/09-2904.1

Cited by 44 publications

(49 citation statements)

References 35 publications

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“…16,18,34 Distal protection devices were successfully deployed in 49 (5%) of the cases reported. 27,29,30,36,38 No differences were found in periprocedural stroke rates with or without distal protection devices.…”

Section: Safety and Technical Feasibilitymentioning

confidence: 99%

“…25,28,33 A total of 7 cases described stent fracture identified at follow-up angiography. 28,29,32 The reports cited in this review describe a total of 13 patients who underwent primary angioplasty for vertebral origin stenosis. Two of these had a residual stenosis of 50%, whereas the remainder constituted an initial angiographic success.…”

Section: Safety and Technical Feasibilitymentioning

confidence: 99%

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A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

Stayman

Nogueira²,

Gupta³

2011

Stroke

130

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Background and Purpose-Extracranial vertebral artery stenosis (ECVAS) is common among patients with ischemic stroke. Despite the limited knowledge of the natural history of patients with symptomatic vertebral disease, endovascular revascularization techniques are now utilized in clinical practice. We sought to determine the risk of endovascular treatment for ECVAS with a systematic review of the literature. Methods-A search strategy was used using the terms "stenting," "vertebral," "ostium," "origin," and "extracranial" through Medline. All articles were reviewed along with their references to determine the risk and durability of endovascular treatment. Results-A total of 27 articles were identified that met inclusion criterion, with a total of 980 of 993 patients treated with stents. The majority of patients (56%) were noted to have contralateral vertebral artery stenosis or occlusion and 92% were symptomatic at the time of treatment. A total of 11 patients (1.1%) experienced a stroke and 8 (0.8%) experienced a transient ischemic attack within 30 days of the procedure. Drug-eluting stents were associated with lower restenosis rates (11%) compared to bare metal stents (30%) at a mean of 24 months of follow-up. Conclusions-Stenting and angioplasty of ECVAS appear to have a low rate of periprocedural stroke or transient ischemic attack and restenosis rates that may not be as high as suspected. Given the frequency of ECVAS as an etiology for ischemic stroke, future studies aimed at determining efficacy of this treatment modality relative to medical therapy would be of benefit to clinicians caring for these patients. (Stroke. 2011;42:2212-2216.)

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Section: Safety and Technical Feasibilitymentioning

confidence: 99%

Section: Safety and Technical Feasibilitymentioning

confidence: 99%

A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

Stayman

Nogueira²,

Gupta³

2011

Stroke

130

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“…In a recent system review, a lower restenosis rate of DES (11%) compared to bare metal stents (BMS) (30%) at a mean of 24 months of follow-up was reported for extracranial VA 2 . However, others also described high rates of stent fracture for DES, which might be the major contributing factor to ISR 3,4 . Compared to balloon-expandable stents (BES), self-expanding stents (SES) have enhanced radial expanding force and greater flexibility.…”

Section: Introductionmentioning

confidence: 99%

Stent Fracture and Occlusion after Treatment of Symptomatic Vertebral Artery Ostium Stenosis with a Self-Expanding Device

Liu

Wang

2014

Interv Neuroradiol

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Endovascular stenting with a balloon expandable device is currently the preferred treatment modality for symptomatic proximal vertebral artery stenosis, but high rates of in-stent restenosis remain a major problem, for which stent fracture might be a contributing factor. Limited reports showed that placement of self-expanding stents in the proximal vertebral artery might reduce restenosis; no stent fracture has been reported to date. We describe here a new case of fracture and occlusion of a self-expanding stent after endovascular treatment of symptomatic vertebral artery ostium stenosis.

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“…3,9,14,21) However, a systematic review of percutaneous revascularization of extracranial VA stenosis found no differences in periprocedural stroke rates with or without protection devices. 16) Similarly, the endovascular treatment without an embolic protection device performed in our case did not result in procedural thromboembolic complication.…”

Section: Discussionmentioning

confidence: 99%

“…13) Percutaneous endovascular treatment of extracranial VA disease is not as technically challenging as surgical procedures, and as such, endovascular angioplasty is a valuable alternative. 2,7,9,16,20,21) Common endovascular angioplasty is performed after a wire device is navigated across the lesion. However, if the origin of the VA is not visualized, manipulation of the wire may be difficult.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Angioplasty for Extracranial Vertebral Artery Occlusion Without Visualization of the Stump of the Artery Ostium

Nii¹,

Abe²,

Iko³

et al. 2013

Neurol. Med. Chir.(Tokyo)

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An 87-year-old man presented with extracranial vertebral artery (VA) occlusion and progressive vertebrobasilar ischemia despite maximal medical management. Cerebral angiography showed left proximal VA occlusion, termination of the right VA at the ipsilateral posterior inferior cerebellar artery, and hypoplastic bilateral posterior communicating arteries. Although the stump of the left VA ostium was not visualized, the distal patent artery was reconstituted via muscular branches from the left subclavian artery (SCA). Endovascular angioplasty with a stent for left VA occlusion was performed. The nonvisualized VA ostium was extrapolated from the computed tomography angiography findings of the distal patent VA and the partial calcification of the SCA. The occluded VA was penetrated by the guide wire and revascularized by balloon angioplasty with the stent using the support of a snare wire inserted via the left brachial artery for stabilization of the guide catheter. This treatment resulted in resolution of the severe neurological findings.

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Drug-Eluting Stents for the Treatment of Vertebral Artery Origin Stenosis

Cited by 44 publications

References 35 publications

A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

Stent Fracture and Occlusion after Treatment of Symptomatic Vertebral Artery Ostium Stenosis with a Self-Expanding Device

Endovascular Angioplasty for Extracranial Vertebral Artery Occlusion Without Visualization of the Stump of the Artery Ostium

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