Vertebral artery stenting using distal emboli protection and transcranial Doppler

Mintz, Edward P; Gruberg, Luis; Kouperberg, Efim

doi:10.1002/ccd.10710

Cited by 27 publications

(18 citation statements)

References 15 publications

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“…However, embolic complications were described in these series, as distal protection devices were not utilized. There has been a single previous case report of distal protection embolic filter used in vertebral artery stenting with a bare metal stent with good results (10). Embolic distal protection devices are routinely employed in carotid artery stenting.…”

Section: Discussionmentioning

confidence: 99%

Vertebral artery stenting utilizing distal embolic protection with filter wire and a drug‐eluting Taxus stent

Sharma

Bhambi

2006

Acute Cardiac Care

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Section: Discussionmentioning

confidence: 99%

Vertebral artery stenting utilizing distal embolic protection with filter wire and a drug‐eluting Taxus stent

Sharma

Bhambi

2006

Acute Cardiac Care

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“…The use of EPDs has been described in several studies involving angioplasty and stenting of lesions of a VA origin [1,5,7,9,10,12,13,14]. To date, newer or alternative methods for cerebral protection for the treatment of vertebrobasilar (VB) stenosis have not yet been elucidated.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the evidentiary support for protection devices in the treatment of carotid artery lesions, EPD use has translated into percutaneous interventions of proximal vertebral artery (VA) stenosis [9,12]. Lesions of a VA origin and at the V1 segment lend themselves well for distal embolic protection as vessel size approximates the coronaries; there are several devices available for use.…”

Section: Introductionmentioning

confidence: 99%

The Use of Aspiration Catheter Systems for Embolic Protection during Intracranial Vertebral Artery Angioplasty and Stenting

2015

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Background: Posterior circulation strokes comprise approximately 20-25% of all strokes of ischemic origin. Strokes affecting this area carry a significantly higher risk for subsequent stroke or death as compared to anterior circulation strokes. Embolic protection device (EPD) use for carotid artery stenosis has translated into percutaneous interventions of proximal vertebral artery (VA) stenosis. However, the use of EPDs when treating intracranial lesions has yet to be studied and may not be feasible as the vessel caliber is frequently smaller than in existing devices. Objective: The aim of this study is to describe a proximal aspiration technique used during the treatment of intracranial VA and basilar artery (BA) atherosclerotic disease. Methods: Proximal embolic protection was utilized during the treatment of intracranial VA/BA stenosis with angioplasty and stenting in patients with medically refractory disease. Results: Three patients with severe symptomatic posterior circulation stenosis refractory to medical management were treated with angioplasty and stenting utilizing proximal aspiration. Pre- and post-treatment angiograms and MRIs were compared. Treated vascular stenoses were significantly improved, without new neurological deficits or ischemic injury identified on imaging. Conclusions: The proposed technique of proximal embolic protection may help overcome the challenge of embolus propagation inherent to the treatment modality that was encountered during the treatment of intracranial VA/BA stenosis.

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“…29 There were a few anecdotal case reports regarding the protection technique in recanalization of a V1 occlusion by use of a flow-reversal technique 30,31 or a distal filter protection device. 32 Our clinical experience has shown that smooth passage of a 0.035-inch guidewire could be followed by the introduction of a 4F angiocatheter, which allows clot aspiration and also accepts a distal balloon system with a 0.014-inch outer diameter. A more rigid microguidewire can also be used for probing the occluded segment.…”

Section: Discussionmentioning

confidence: 99%

Recanalization of Symptomatic Vertebral Ostial Occlusion in Patients with Acute or Subacute Stroke

Park

Lee

Shim

et al. 2013

American Journal of Neuroradiology

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SUMMARY:Vertebral artery recanalization in symptomatic stenosis/occlusion remains controversial, as no definite evidence exists regarding this topic. There are only a few reports regarding the feasibility and safety of recanalization in the first segment of the vertebral artery with atherosclerotic vertebral ostial occlusion. We report our experience treating first segment occlusion in 8 patients and present a balloon protection technique used to reduce the thromboembolic burden during the stent placement procedure. The outcome at 3 months showed an mRS Յ2 except for a patient with a poor initial status with basilar artery occlusion. Revascularization of a rather long first segment occlusion is technically feasible and can be safely performed by use of embolic protection methods. A therosclerotic lesions of the vertebral artery (VA) origin are a potential cause of posterior circulation ischemia, which has approximately a 20% to 50% risk for vertebrobasilar TIA or stroke. ABBREVIATIONS:1 The VA ostium is known to be the most common site for atherosclerosis of the posterior circulation. 2 Patients with symptomatic severe (Ͼ 70%) ostial VA stenosis face an 11% annual risk for recurrent stroke or TIA while receiving medical treatment. 3Early understanding of the stroke mechanism of VA ostial lesions was focused on their hemodynamic nature, which commonly presents with TIA including dizziness.4 After a few case series that described an embolic infarct originating from vertebral ostial occlusive disease, 5 artery-to-artery embolism was also considered as an important cause of the stroke mechanism in lesions in the first segment of the VA (V1). 6 A large series of patients revealed that half of the artery-to-artery embolic strokes in the posterior circulation were the result of VA ostial lesions. 7 The presence of a clot in the vertebral ostial plaque provides the causeand-effect relationship between vertebral arterial ostial lesions and posterior circulation stroke. 8 Even a large ulcer in the vertebral arterial ostium has been described as adding to the possibility of the vertebral arterial ostium as a source of emboli. 9The optimal treatment of patients with symptomatic severe ostial VA stenosis is still unclear.3 The only randomized trial comparing endovascular with medical treatment is the Carotid and VA Transluminal Angioplasty Study. 10 This study did not show a separate result for the small number of its patients (nϭ16) with VA stenosis, though it failed to demonstrate the benefit of angioplasty of carotid and vertebral stenosis. Although several articles have dealt with revascularization of vertebral ostial lesions, they mostly have described revascularization of vertebral arterial stenosis.11 To our knowledge, only a few case reports have demonstrated anecdotal evidence of revascularization for vertebral ostial occlusion. 12 Therefore, we present the revascularization procedure and the outcome of vertebral ostial occlusion in strokes related to artery-to-artery embolism. MATERIALS AND METHODS Case SeriesEight...

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Vertebral artery stenting using distal emboli protection and transcranial Doppler

Cited by 27 publications

References 15 publications

Vertebral artery stenting utilizing distal embolic protection with filter wire and a drug‐eluting Taxus stent

Vertebral artery stenting utilizing distal embolic protection with filter wire and a drug‐eluting Taxus stent

The Use of Aspiration Catheter Systems for Embolic Protection during Intracranial Vertebral Artery Angioplasty and Stenting

Recanalization of Symptomatic Vertebral Ostial Occlusion in Patients with Acute or Subacute Stroke

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