Extracranial vertebral artery stent placement: in-hospital and follow-up results

Chastain, Hollace D.; Campbell, Morgan; Iyer, Sriram S.; Roubin, Gary S.; Vitek, Jiri J.; Mathur, Atul; Al-Mubarak, Nadim; Terry, John B.; Yates, Virginia; Kretzer, Kimberly; Alred, Diane; Gomez, Camilo R.

doi:10.3171/jns.1999.91.4.0547

Cited by 123 publications

(58 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…El éxito técnico se definió como una estenosis residual < 20% y se produjo en un 99,3% de los casos incluidos en esta revisión. El fallo del despliegue del stent se atribuyó a la tortuosidad importante del origen de la vertebral en 1 serie 22 . Se describieron casos aislados de desalojo o migración de stents 25,28,33 .…”

Section: Discusión Seguridad Y Viabilidad Técnicaunclassified

See 1 more Smart Citation

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

Stayman

Nogueira²,

Gupta³

2011

Stroke

135

View full text Add to dashboard Cite

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.)

show abstract

Section: Discusión Seguridad Y Viabilidad Técnicaunclassified

“…Failure of stent deployment was attributed to severe tortuosity of vertebral origin in 1 series. 22 There were isolated reports of stents that dislodged or migrated. 25,28,33 A total of 7 cases described stent fracture identified at follow-up angiography.…”

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

135

View full text Add to dashboard Cite

show abstract

“…VA angioplasty was first performed in 1980 by Sundt et al Numerous clinical studies conducted since then have indicated the importance of angioplasty and stenting in the treatment of vertebrobasilar atherosclerotic disease (13)(14)(15)(16)(17). Technical success depends on the development of materials used in endovascular treatment, the degree of stenosis, the vascular tortuosity, and the experience of the neuroradiologist who performs the procedure.…”

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

View full text Add to dashboard Cite

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...

show abstract

“…Available data on such interventions are derived from small case series. [85][86][87][88] Ongoing clinical trials are addressing the role of endovascular treatment for these indications.…”

mentioning

confidence: 99%

Secondary Prevention of Atherothrombotic Events After Ischemic Stroke

Adams

2009

Mayo Clinic Proceedings

View full text Add to dashboard Cite

Atherosclerotic vascular disease is the leading cause of ischemic stroke, resulting in occlusive or severely stenotic lesions of major intracranial or extracranial arteries and narrowing of small penetrating arteries of the brain. Atherosclerosis of the coronary arteries (ie, coronary artery disease) is an indirect cause of cardioembolic stroke secondary to myocardial infarction. Ischemic heart disease may also be complicated by atrial fibrillation and cardioembolic stroke. Prevention of recurrent stroke and other ischemic events, including myocardial infarction, is a key component of treatment for patients with symptomatic ischemic cerebrovascular disease. Prevention of recurrent stroke involves controlling those factors that promote the course of atherosclerosis, including hypertension, hyperlipidemia, diabetes mellitus, and smoking, as well as such local interventions as carotid endarterectomy and endovascular treatment. Nevertheless, administration of antiplatelet agents remains the core of management for preventing recurrent stroke and other cardiovascular events in at-risk patients.

show abstract

Extracranial vertebral artery stent placement: in-hospital and follow-up results

Cited by 123 publications

References 25 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

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

Secondary Prevention of Atherothrombotic Events After Ischemic Stroke

Contact Info

Product

Resources

About