The long term results of vertebral artery ostium stenting in a single center

Abstract

Stenting for VAO stenosis seems to be safe and efficacious. The majority of recurrent events were TIAs, which may be related to ISR, stent fracture, vessel tortuosity, and hyperlipidemia.

Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

“…The relationship between VA restenoses and recurrent symptoms is unclear. After VA stenting, ISR affects 11e45% of patients, 454,472 while stent fracture is not uncommon and has been associated with a higher prevalence of recurrent events. 471 The pathophysiology of stent fracture and ISR is probably mechanical irritation from the fractured struts causing smooth muscle proliferation and impaired reendothelisation within the proximal VA.…”

Dynamic Respiratory Tortuosity of the Vertebral Artery Ostium

“…Of the 65 patients undergoing vertebral artery stenting, 54 patients (mean age 67.3±5.3 years; 40 men) had stents placed at the ostium; their characteristics are given in Table 2. Indications for VAO stenting were: (1) VAO stenosis ≥70% compared with the distal reference vessel diameter on angiography 1–4,8,9 ; (2) vertebrobasilar symptoms refractory to maximal medical therapy with antiplatelet agents and statins for at least 3 months; and (3) no other substantial vertebrobasilar stenotic lesions in the corresponding vascular territory. Acute or subacute vertebrobasilar stroke was routinely ruled out by magnetic resonance imaging during evaluation.…”

“…Stenting has become a commonly accepted therapeutic option for patients with symptomatic vertebral artery ostium (VAO) stenosis, though it is still plagued by in-stent restenosis (ISR). 1–7 Use of drug-eluting stents (DES) has significantly reduced ISR in the coronary arteries and could be as efficacious in VAO stenting. 2,8,9 However, long-term follow-up studies have shown a high incidence of vertebral artery stent fracture commonly associated with ISR.…”

Recent advances in the management of transient ischemic attacks

“…In patients with TIA and extracranial vertebral artery stenosis, despite the existing literature 179 – 181 , the guidelines suggest that stenting be reserved for patients who remain "symptomatic" despite optimal medical therapy, including risk factor modification and antithrombotic agents 174 . The recommendation for patients with intracranial atherosclerosis, even those with severe stenosis, is that they are managed with maximal medical therapy 174 , based on the results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study 182 , 183 .…”