Comparison of hemodynamic changes and prognosis between stenting and standardized medical treatment in patients with symptomatic moderate to severe vertebral artery origin stenosis

Abstract

This study aimed to compare the clinical efficacy of stenting compared with standardized medical treatment in patients with moderate to severe vertebral artery origin stenosis (VAOS). Patients diagnosed with moderate to severe VAOS and indicated to undergo vertebral artery stenting were enrolled. Patients were divided into stenting group and standardized medical treatment group. All patients underwent transcranial Doppler (TCD) before and after treatment. Incidence of new cerebral infarction, transient ischemic attack (TIA), improvement of clinical symptoms, and National Institutes of Health Stroke Scale (NIHSS) score were observed. A total of 98 patients were enrolled. Vertebral artery stenting implant was accepted by 43 patients. Two weeks after treatment, the NIHSS score in the stenting group decreased significantly compared to that in the standardized medical treatment group. The modified Rankin Scale (mRS) score in the stenting group at three months was significantly lower than that in the medical treatment group ( P = .044). The extent of vascular stenosis in the stent group decreased significantly (76.5 ± 10.0% vs. 13.7 ± 5.9%, t = 35.878, P = .000). The adverse events occurred in 9 (16.4%) patients in the medical treatment group and 5 (11.6%) in the stenting group ( P = .506). There was one case with new cerebral infarction in the stenting group, whereas the medical treatment group showed 1 case with TIA and three with new cerebral infarction during follow-up after 3 months. The peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) of stenosis vertebral artery, and PSV of basilar artery were significantly higher in the stent group than those in the standardized medical group ( P < .05). Stenting for VAOS, rather than standardized medical treatment, can effectively relieve vascular stenosis, alter vertebral-basilar artery hemodynamics, and improve neurological function, with low perioperative complications.

Long-term outcomes of drug-eluting stent implantation in patients with symptomatic extra- and intracranial atherosclerotic stenoses

“…Thereafter, additional endovascular treatments to prevent recurrent stroke have been suggested. Several studies revealed that performing PTAS under specific conditions might be helpful for patients with recurrent ischemic symptoms who fail medical therapy, although periprocedural complications and ISR still remain major issues in PTAS, affecting the longterm prognosis [ 7 , 20 , 25 ].…”

“…Several studies revealed that performing PTAS under specific conditions might be helpful for patients with recurrent ischemic symptoms who fail medical therapy, although periprocedural complications and ISR still remain major issues in PTAS, affecting the longterm prognosis. 7)20) 25) The poor outcome of PTAS in these previous trials may be attribute to the high rate of periprocedural www.the-jcen.org complications. These studies had several limitations regarding complications that need to be addressed.…”

“…4)5)21)30) Nevertheless, PTAS has still been considered in a certain group of patients with extraand intracranial stenoses who present recurrent strokes despite medical therapy, and several studies have shown favorable outcomes. 7)20) 25) On the other hand, the development of novel devices and techniques in recent decades contributed to a more effective and safer treatment in endovascular neurosurgery. One of them is the implantation of drug-eluting stents (DES).…”

“…However, PTAS has not been yet recommended as the first-line treatment for patients with symptomatic extra- and intracranial stenoses, because evidence showing better outcomes from PTAS compared to the aggressive medical treatment without endovascular procedures is lacking from large-scale randomized clinical trials [ 4 , 5 , 21 , 30 ]. Nevertheless, PTAS has still been considered in a certain group of patients with extra- and intracranial stenoses who present recurrent strokes despite medical therapy, and several studies have shown favorable outcomes [ 7 , 20 , 25 ].…”

Case Report: Double Micro-Guidewire Technique for Emergent Rescue of Proximal Stent Collapse During Recanalization of Nonacute Occlusion of Vertebral Artery

“…As a major health burden worldwide, strokes result in a high rate of morbidity and mortality (1,2). Intracranial atherosclerosis accounts for ∼5-10% of all strokes and transient ischemic attacks in the world (1), whereas in Asia, intracranial atherosclerotic stenosis is responsible for 33-37% of acute ischemic strokes (3).…”