Endovascular treatment of the vertebral artery origin stenosis by using the closed-cell, self-expandable Carotid Wallstent

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Endovascular treatment has been considered a good alternative to surgery for symptomatic vertebral artery origin stenosis (VAOS) due to the high risk of morbidity associated with surgery. The purpose of this study was to evaluate the feasibility and efficacy of insertion of the closed-cell, self-expandable Carotid Wallstent for the treatment of VAOS. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> The records of 72 patients with VAOS refractory to adequate medication who were treated by endovascular treatment with the Carotid Wallstent from December 2006 to November 2018 were retrospectively evaluated. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Of the 72 patients, 43 presented with transient ischemic attacks. Forty-seven patients (65.3%) manifested other brachiocephalic stenoses; of these, 40 patients had occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Overall technical success (defined as 20% or less residual stenosis) was 100%. Procedure-related complications ( n = 8, 11.1%) included sudden asystole ( n = 1), acute in-stent thrombosis ( n = 3), minor stroke ( n = 3), and stent shortening ( n = 1). All complications were resolved without permanent neurological deficit. Angiographic follow-up (mean, 13.0 months) was achieved in 49 patients and revealed in-stent restenosis in 1 patient (2.0%) and stent malposition by shortening in 2 patients (4.1%). Follow-up records were available in 57 patients (mean 15.6 months). Three of the 57 patients ( n = 3, 5.3%) had recurrent symptoms of vertebrobasilar ischemia and none was retreated. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Endovascular treatment of symptomatic VAOS using the closed-cell, self-expandable Carotid Wallstent is technically feasible and effective in alleviating patient symptoms and for improving vertebrobasilar blood flow. </jats:p></jats:sec>

An attractive endovascular strategy for combined – aneurysmal and stenotic – coronary artery disease

“…The Herculink stent (Abbott Vascular), approved for the management of renal artery stenosis, was considered, 3 but its 18 mm maximum length did not ensure a complete lesion coverage, unless an overlap stenting was performed. Our choice veered instead on the Carotid Wallstent since previous experiences supported its employment in arteries other than the carotids 4 . We deemed this stent appropriate both for its 7.0 mm caliber and 30 mm length.…”

“…Our choice veered instead on the Carotid Wallstent since previous experiences supported its employment in arteries other than the carotids. 4 We deemed this stent appropriate both for its 7.0 mm caliber and 30 mm length. Furthermore, self-expandable stents had already proved helpful for the treatment of coronary aneurysms, thanks to their adaptability to significantly varying vessel calibers.…”