Vertebral artery stenting

Jenkins, J. Stephen; White, Christopher J.; Ramee, Stephen R.; Collins, Tyrone J.; Chilakamarri, Vijay K.; McKinley, Kevin L.; Jain, Suresh P.

doi:10.1002/ccd.1228

Cited by 80 publications

(34 citation statements)

References 11 publications

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“…Hence, our findings suggest that vertebral stenosis patients with clinical features similar to those randomized in CAVATAS may have a low risk of recurrent vertebrobasilar territory stroke, even when treated with medical treatment alone. Previous case series showing a low rate of recurrent stroke after endovascular treatment of symptomatic vertebral stenosis have been interpreted as demonstrating effective stroke prevention, 13,15 but this conclusion must be open to question if our findings in the medical arm are a reflection of the true risk. However, it is possible that our results have been unduly affected by chance because of the small numbers of patients randomized.…”

Section: Discussionmentioning

confidence: 86%

Long-Term Outcome After Angioplasty and Stenting for Symptomatic Vertebral Artery Stenosis Compared With Medical Treatment in the C arotid A nd V ertebral A rtery T ransluminal A ngioplasty S tudy (CAVATAS)

Coward

McCabe

Ederle

et al. 2007

Stroke

179

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on behalf of the CAVATAS Investigators* Background and Purpose-The long-term outcome of endovascular intervention compared with best medical management of patients with symptomatic vertebral artery stenosis is uncertain. We therefore compared these treatments in a randomized trial with long-term follow-up. Methods-In the international, multicenter Carotid And Vertebral Artery Transluminal Angioplasty Study, 16 patients with symptomatic vertebral artery stenosis were randomized in equal proportions to receive endovascular therapy (balloon angioplasty or stenting) or best medical treatment alone. An independent neurologist followed up the patients for as long as 8 years. Results-Endovascular intervention was technically successful in all 8 patients, but 2 patients experienced transient ischemic attack at the time of endovascular treatment. There were no deaths or strokes in any arterial territory within the first 30 days. During a mean follow-up period of 4.7 years, no patient in either treatment group experienced a vertebrobasilar territory stroke, but 3 patients in each treatment arm died of myocardial infarction or carotid territory stroke, and 1 endovascular patient had a nonfatal carotid territory stroke. Conclusions-Patients with vertebral artery stenosis were more likely to have carotid territory stroke and myocardial infarction during follow-up than have recurrent vertebrobasilar stroke. The trial failed to show a benefit of endovascular treatment of vertebral artery stenosis, but the numbers of patients included was small. Larger randomized trials are required to determine whether vertebral artery stenting is justified in patients at higher risk of vertebrobasilar stroke. Treatment of patients with vertebral artery stenosis should focus on global reduction of vascular risk, including prevention of carotid territory stroke and myocardial infarction.

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Section: Discussionmentioning

confidence: 86%

Long-Term Outcome After Angioplasty and Stenting for Symptomatic Vertebral Artery Stenosis Compared With Medical Treatment in the C arotid A nd V ertebral A rtery T ransluminal A ngioplasty S tudy (CAVATAS)

Coward

McCabe

Ederle

et al. 2007

Stroke

179

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“…185,186 Retrospective case series have shown that the procedure can be performed with a high degree of technical success. [187][188][189][190] Long-term follow-up data are limited, and further randomized studies are needed to more clearly define evidence-based recommendations in this setting.…”

Section: B Extracranial Vertebrobasilar Diseasementioning

confidence: 99%

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack

Sacco¹,

Adams²,

Albers³

et al. 2006

Stroke

1,447

297

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Abstract-The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations. (Stroke. 2006;37:577-617.)

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“…Medical, surgical, and endovascular methods are used in the treatment of VA stenoses (4,5). Endovascular treatment should be considered as a first-line option for patients with posterior system strokes that develop despite appropriate medical treatment or for patients who have asymptomatic bilateral carotid occlusion and in whom collateral circulation is provided only through VA (6, 7).…”

Section: Discussionmentioning

confidence: 99%

“…Previously, stents cut from a tube were used to prevent breakage in the orifice lesions due to the angulation of VA with subclavian artery, while balloon expandable stents are used today. Drug-releasing stents may also reduce restenosis in this region where restenosis is more prominent (5,14,19). VA balloon angioplasty and anticoagulant and antithrombotic treatment protocols as a medical therapy after stenting are the standard applications indicated in the literature (20,21).…”

Section: Discussionmentioning

confidence: 99%

Stenting for Severe Vertebral Artery Orifice Stenosis in A Case of Three Cerebral Artery Occlusion

Çabalar¹,

Resulova²,

Taşdemir³

et al. 2017

Istanbul Med J

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The vertebrobasilar system (VBS) is responsible for causing 25% of ischemic strokes (1, 2). Approximately one-fifth of the posterior system strokes are caused due to the stenosis developing at the exit site of the extracranial vertebral artery (VA) from the subclavian artery (3). VA orifice stenoses are among the correctable causes of posterior system strokes that can be treated using developed imaging and treatment modalities. Case ReportA 51-year-old male patient visited our clinic with a complaint of speech impairment and weakness on the left side. He had undergone a surgery for aortic coarctation 13 years ago and for transient ischemic episodes progressing along with speech impairment 5 years ago. Regarding his habits, he had a history of smoking a pack of cigarettes a day for 30 years. Neurological examination showed that he was conscious and cooperative and his orientation was complete. His speech was dysarthric. Left hemiparesis (4/5, 4/5) was detected on the motor examination. Magnetic resonance imaging revealed right hemisphere caudate nucleus and frontoparietal fragmented acute infarct (Figure 1). Acetylsalicylic acid (ASA) 100 mg and enoxaparin 0.6 mL 2 × 1 were started subcutaneously as treatment. Vasculitis examinations did not show any characteristics. The ejection fraction (EF) was 60%, and the left ventricular systolic functions were normal in transesophageal echocardiography (TEE). The right VA had a dolichoectasia appearance in color Doppler ultrasonography (CDU). The total VA current was 267 mL/min. Cranial and cervical magnetic resonance angiography (MRA) showed that cerebral blood flow was provided only by the narrow right VA (Figure 2). There was a slight deterioration in the left hemiparesis (2/5, 4/5) during the hospitalization. During cerebral digital subtraction angiography (DSA) performed by the neuroradiology team, a guiding catheter was inserted in the right VA because of the advanced occlusion in both ICAs (internal carotid arteries) and in the left VA outflow tract and 80% stenosis in the right VA orifice. The stenosis level was passed using a 0.14 guidewire through the guiding catheter, and a 6 × 12 mm balloon expandable stent was brought to the place of stenosis through the guidewire and opened. The procedure was terminated after the stent lumen was monitored open in the control images (Figure 3). Dysarthria and left hemiparesis (3/5,-5/5) were detected on the final neurological examination of the patient. Prasugrel 10 mg/ day and ASA 300 mg/day were started as medical treatment due to clopidogrel resistance (92 U, sensitivity 24 U), and then the patient was discharged. At the first-and fifth-month Stenting for Severe Vertebral Artery Orifice Stenosis in A Case of Three Cerebral Artery Occlusion A 51-year-old male presented with dysarthria and weakness on his left side. In his history, he had an operation due to aortic coarctation 13 years ago, and 5 years ago, he had a transient ischemic attack along with difficulty in speaking. During his neurological examination, he was consci...

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Vertebral artery stenting

Cited by 80 publications

References 11 publications

Long-Term Outcome After Angioplasty and Stenting for Symptomatic Vertebral Artery Stenosis Compared With Medical Treatment in the C arotid A nd V ertebral A rtery T ransluminal A ngioplasty S tudy (CAVATAS)

Long-Term Outcome After Angioplasty and Stenting for Symptomatic Vertebral Artery Stenosis Compared With Medical Treatment in the C arotid A nd V ertebral A rtery T ransluminal A ngioplasty S tudy (CAVATAS)

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack

Stenting for Severe Vertebral Artery Orifice Stenosis in A Case of Three Cerebral Artery Occlusion

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