Experience with vertebral artery origin stenting and ostium dilatation: results of treatment and clinical outcomes

Rangel-Castilla, Leonardo; Gandhi, Sirin; Munich, Stephan A; Cress, Marshall C.; Sonig, Ashish; Krishna, Chandan; Hopkins, L. Nelson; Snyder, Kenneth V.; Levy, Elad I.; Siddiqui, Adnan H.

doi:10.1136/neurintsurg-2015-011655

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…Endovascular treatments such as balloon dilation or stenting have become the leading surgical modalities for proximal VASO because of their simplicity, low perioperative complications, and high success rates. However, high restenosis rate (up to 30%) is an essential drawback of endovascular treatment (11,12). Although drug balloons or drug-eluting stents may reduce restenosis, they are still associated with higher restenosis rates of 11-30% as previously reported (13,14).…”

Section: Introductionmentioning

confidence: 91%

Microsurgical revascularization of a symptomatic proximal vertebral artery: pilot experiences from a single center

Zhou

et al. 2023

Front. Neurol.

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BackgroundVertebral artery stenosis and occlusion (VASO) is a high-risk factor for posterior circulation stroke. Post-stent restenosis and drug tolerance have facilitated the exploration of microsurgical vascular reconstruction. This study aims to evaluate the safety and efficacy of microsurgical reconstruction of the proximal VA.MethodsTwenty-nine patients (25 men, aged 63.2 years) who had symptoms of posterior circulation ischemia underwent microsurgical revascularization for proximal VASO were retrospectively included in this study. Procedural complications and clinical and angiographic outcomes were reviewed.ResultsTwelve, three, and five patients underwent VA endarterectomy, artery transposition, or both, respectively; seven patients underwent vertebral endarterectomy plus stent implantation; and two patients failed surgery because of the difficult exposure of the VA and the occurrence of vascular dissection. The perioperative period-related complications included seven cases of Horner’s syndrome, five cases of hoarseness, and one case of chylothorax. No cases of perioperative stroke or death were reported. The mean follow-up period was 28.4 (8–62 months). Most patients improved clinically; however, the vertebrobasilar ischemia symptoms did not decrease significantly in two patients during the follow-up. Moreover, follow-up imaging was performed in all the patients, and no signs of anastomotic stenosis were reported.ConclusionMicrosurgical reconstruction is an alternative option that can effectively treat refractory proximal VASO disease and in-stent stenosis, with a high rate of postoperative vascular recirculation. Prospective cohort studies with larger sample sizes must be conducted to validate the above conclusions.

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Section: Introductionmentioning

confidence: 91%

Microsurgical revascularization of a symptomatic proximal vertebral artery: pilot experiences from a single center

Zhou

et al. 2023

Front. Neurol.

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“…Their pre-surgical average mRS score was 1.25. All study patients, having previously failed to respond to medical therapy, underwent stenting and dual balloon Flash angioplasty [ 21 ].…”

Section: Reviewmentioning

confidence: 99%

“…After an average follow-up of 10.8 months (ranging from 2 to 24), all patients experienced symptom resolution, and on neuroimaging or Doppler studies, there were no signs of symptomatic restenosis. The average mRS score was 0.66, indicating a positive outcome [ 21 ].…”

Section: Reviewmentioning

confidence: 99%

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Endovascular Approach in Treating Vertebrobasilar Insufficiency: A Systematic Review

Awawdeh,

Soti

2024

Cureus

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Vertebrobasilar insufficiency (VBI) is a significant medical condition that results from a lack of adequate blood flow to the posterior circulation of the brain. The first-line treatment involves the use of antiplatelet therapy, but in cases where patients are not responsive to drug therapy, surgical management is the next viable option. In the past, open endarterectomy was the preferred surgical approach for treating critical VBI patients. However, due to its high mortality rates and severe peri-procedural complications, its usage has decreased. Instead, the endovascular approach has emerged as an alternative surgical option for resolving VBI. This review explores the current literature to assess the effectiveness of endovascular interventions in treating VBI patients. It also highlights potential complications and adverse effects associated with these treatments while identifying gaps in the current research that warrant further investigation. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to extensively search relevant literature on endovascular approaches for treating VBI patients on PubMed, BioMed Central, and ClinicalTrials.gov . The findings suggest that endovascular treatments have demonstrated significant technical success in treating VBI, with low mortality rates and minor adverse effects, such as intracranial hemorrhage and restenosis. The overall incidence of these complications is relatively low. Combining medical therapies with endovascular interventions has improved outcomes and reduced restenosis rates. However, there are methodological limitations and inconsistencies in the current literature that necessitate further investigation. Future research should focus on larger, randomized clinical trials and direct comparisons with other treatment options to obtain more conclusive evidence.

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Stenting of the Great Vessels

Morrison

Shakir

Davies

et al. 2018

Cerebrovascular and Endovascular Neurosurgery

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Experience with vertebral artery origin stenting and ostium dilatation: results of treatment and clinical outcomes

Abstract: Safety and feasibility were demonstrated using the Ostial Flash system for VAO stenting and angioplasty. No permanent perioperative complications were seen.

Cited by 7 publications

References 22 publications

Microsurgical revascularization of a symptomatic proximal vertebral artery: pilot experiences from a single center

Microsurgical revascularization of a symptomatic proximal vertebral artery: pilot experiences from a single center

Endovascular Approach in Treating Vertebrobasilar Insufficiency: A Systematic Review

Stenting of the Great Vessels

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