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

• Published in: Journal of neurosurgery Vol. 91; no. 4; pp. 547 - 552
• Main Authors: CHASTAIN, H. D, CAMPBELL, M. S, ALRED, D, GOMEZ, C. R, IYER, S, ROUBIN, G. S, VITEK, J, MATHUR, A, AL-MUBARAK, N. A, TERRY, J. B, YATES, V, KRETZER, K
• Format: Journal Article
• Language: English
• Published: Park Ridge, IL American Association of Neurological Surgeons 01-10-1999
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cerebral Angiography; Feasibility Studies; Female; Follow-Up Studies; Humans; Inpatients; Male; Medical sciences; Middle Aged; Neurology; Postoperative Complications - mortality; Recurrence; Stents; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vertebral Artery - diagnostic imaging; Vertebral Artery - surgery; Vertebrobasilar Insufficiency - diagnostic imaging; Vertebrobasilar Insufficiency - surgery; Human; Nervous system diseases; Instrumentation therapy; Cardiovascular disease; Instrumental dilatation; Vertebrobasilar insufficiency; Stent; Cerebral disorder; Percutaneous route; Vascular disease; Treatment; Central nervous system disease; Cerebrovascular disease
• ISSN: 0022-3085; 1933-0693
• DOI: 10.3171/jns.1999.91.4.0547

The authors summarize their experience with stent deployment in the treatment of vertebrobasilar artery (VBA) insufficiency. This is an underdiagnosed condition, and the incidence of significant vertebral artery (VA) stenosis has been underappreciated. Medical therapy has been the mainstay of treatment because of the high rate of morbidity associated with surgical correction of VA stenosis. Recently, some authors have reported acceptable results with the use of percutaneous transluminal angioplasty, but this technique has significant weaknesses such as elastic recoil and problems in achieving safe treatment of dissections.
The authors investigated the feasibility, safety, and outcome of VA stent placement in 50 patients in whom 55 vessels were treated using stents. Technical success was achieved in 54 (98%) of 55 vessels, with no procedure-related complications. However, one patient (2%) died of nonneurological causes, and one (2%) suffered a stroke that occurred within the 30-day postprocedural period and was related to a complicated coronary intervention. Clinical follow-up review performed at a mean of 25 +/- 10 months revealed two patients (4%) with recurrence of VBA symptoms. Six-month angiographic follow up was completed in 90% of eligible patients, with a 10% incidence of restenosis as defined by greater than 50% luminal narrowing.
Vertebral artery stent placement is feasible in patients who have significant VA stenosis, with predictably good angiographically demonstrated and clinical results. The 6-month angiographically confirmed restenosis rate appears to be low, as does the clinical recurrence rate. This technique solves the problems of elastic recoil and the treatment of angioplasty-induced dissections. Further prospective comparison with medical preventive strategies is warranted.