Objective: to evaluate the effectiveness of transluminal angioplasty with stenting in the treatment of atherosclerotic stenosis of the vertebral arteries (VA) proximal segment.
Materials and methods. One hundred twenty-seven patients (97 men and 30 women, mean age 60 years) with symptomatic (72% of patients) and asymptomatic (28% of patients) stenosis of the VA were examined, the degree of stenosis according to X-ray angiography was 76±11%. One hundred fifteen (91%) patients with 127 (91%) implanted stents were surveyed over time (average follow-up time 13 months).
Results. Technical success was achieved in 94% of cases. In the perioperative period, no acute cerebrovascular events, myocardial infarctions or deaths were registered. Recurrence of symptoms of vertebrobasilar insufficiency was noted in 14% initially symptomatic patients. According to ultrasound study data, restenosis ≥50% or reocclusion of the VA stent was detected in 40% cases. Damage to the integrity of the stent was diagnosed in 8% cases, which in all observations was combined with restenosis. Repeated derangement of stent patency after restenting of 11 VA in the period of 4–6 months was revealed in 60% of cases (2 reocclusions and 4 restenoses).
Conclusion. Angioplasty with stenting is a safe and clinically effective method for treating atherosclerotic stenosis of the proximal segment of VA. In a cohort of 50 patients included in the study, low quality of life was observed prior to stenting of VA. Six months after the VA stenting, the quality of life of patients increasesin both physical and psychological aspects. The main problem remains to be a high incidence of restenosis or reocclusion of stents after primary and repeated endovascular intervention in the long-term postoperative period.
Kocak B., Korkmazer B., Islak C. et al. Endovascular treatment of extracranial vertebral artery stenosis. World J Radiol 2012; 4: 391–400. DOI: 10.4329/wjr. v4.i9.391. PMID: 23024840.
Caplan L. Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. Stroke 2000; 31: 2011–2023. PMID: 10926972.
Wityk R., Chang H., Rosengart A. et al. Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 1998; 55: 470–478. PMID: 9561974.
Lee C., Morasch M. Endovascular management of vertebral artery disease. Expert Rev Cardiovasc Ther 2011; 9: 575–578. DOI: 10.1586/erc.11.54. PMID:21615320.
Berguer R., Flynn L., Kline R., Caplan L. Surgical reconstruction of the extracranial vertebral artery: management and outcome. J Vasc Surg 2000; 31(1 Pt 1): 9–18. PMID: 10642704.
Imparato A. Vertebral arterial reconstruction: a nineteen-year experience. J Vasc Surg 1985; 2: 626–634. PMID: 4009848.
Antoniou G., Murray D., Georgiadis G. et al. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg 2012; 55: 1167–1177. DOI: 10.1016/j.jvs.2011.09.084. PMID: 22206680.
Fisher C., Karnes W., Kubik C. Lateral medullary infarction-the pattern of vascular occlusion. J Neuropathol Exp Neurol 1961; 20: 323–379. PMID:13699936.
Hatano T., Tsukahara T., Miyakoshi A. et al. Stent placement for atheroscleroticstenosis of the vertebral artery ostium: angiographic and clinical outcomes in 117 consecutive patients. Neurosurgery 2011; 68: 108–116. DOI: 10.1227/NEU.0b013e3181fc62aa. PMID: 21099720.
Taylor R., Siddiq F., Suri M. et al. Risk factors for in-stent restenosis after vertebral ostium stenting. J Endovasc Ther 2008; 15: 203–212. DOI: 10.1583/07-2175.1. PMID: 18426264.
Lugmayr H., Kastner M., Frohler W. et al. Sirolimus-eluting stents for the treatment of symptomatic extracranial vertebral artery stenoses: early experience and 6-month follow-up. Rofo 2004; 176: 1431–1435. DOI: 10.1055/s-2004-813399. PMID: 15383974.
Seifert T., Augustin M., Klein G. et al. Symptomatic stenosis of the vertebrobasilar arteries: results of extra- and intracranial stent-PTA. Eur J Neurol 2009; 16: 31–36. DOI: 10.1111/j.1468-1331.2008.02297.x. PMID: 19049506.
Stayman A., Nogueira R., Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke 2011; 42:2212–2126. DOI: 10.1161/STROKEAHA.110.611459. PMID: 21700936.
Morice M., Serruys P., Barragan P. et al. Long-term clinical outcomes with sirolimus-eluting coronary stents: five-year results of the RAVEL trial. J Am Coll Cardiol 2007; 50: 1299–1304. DOI: 10.1016/j.jacc.2007.06.029. PMID:
Simsek C., Magro M., Boersma E. et al. The unrestricted use of sirolimusand paclitaxel-eluting stents results in better clinical outcomes during 6-year follow-up than bare-metal stents: an analysis of the RESEARCH (Rapamycin Eluting Stent Evaluated At Rotterdam Cardiology Hospital) and T-SEARCH (Taxus-Stent Evaluated At Rotterdam Cardiology Hospital) registries. JACC Cardiovasc Interv 2010; 3: 1051–1058. DOI: 10.1016/j.jcin.2010.08.003. PMID: 20965464.
Weisz G., Leon M., Holmes D. et al. Five-year follow-up after sirolimuseluting stent implantation results of the SIRIUS (Sirolimus-Eluting Stent in DeNovo Native Coronary Lesions) Trial. J Am Coll Cardiol 2009; 53: 1488–1497. DOI: 10.1016/j.jacc.2009.01.050. PMID: 19389558.
Akins P., Kerber C., Pakbaz R. Stenting of vertebral artery origin atherosclerosis in high-risk patients: bare or coated? A single-center consecutive case series. J Invasive Cardiol 2008; 20: 14–20. PMID: 18174613.
Boulos A., Agner C., Deshaies E. Preliminary evidence supporting the safety of drug-eluting stents in neurovascular disease. Neurol Res 2005; 27(Suppl 1): 95–102. DOI: 10.1179/016164105X35459. PMID: 16197833.
Edgell R., Yavagal D., Drazin D. et al. Treatment of vertebral artery origin stenosis with anti-proliferative drug-eluting stents. J Neuroimaging 2008; 20: 175–179. DOI: 10.1111/j.1552-6569.2008.00330.x. PMID: 19040627.
Gupta R., Al-Ali F., Thomas A. et al. Safety, feasibility, and short-term followup of drug-eluting stent placement in the intracranial and extracranial circulation. Stroke 2006; 37: 2562–2566. DOI: 10.1161/01.STR.0000242481.38262.7b. PMID: 16960090.
Lin Y., Hung C., Tseng W. et al. Safety and feasibility of drug-eluting stent implantation at vertebral artery origin: the first case series in Asians. J Formos Med Assoc 2008; 107: 253–258. DOI: 10.1016/S0929-6646(08)60144-8. PMID: 18400611.
Vajda Z., Miloslavski E., Guthe T. et al. Treatment of stenoses of vertebral artery origin using short drug-eluting coronary stents: improved follow-up results. AJNR Am J Neuroradiol 2009; 30: 1653–1656. DOI: 10.3174/ajnr.A1715. PMID: 19729536.
Yu S., Leung T., Lam J. et al. Symptomatic ostial vertebral artery stenosis: treatment with drug-eluting stents–clinical and angiographic results at 1-year follow-up. Radiology 2009; 251: 224–232. DOI: 10.1148/radiol.2511081057. PMID: 19332854.
Al-Ali F., Barrow T., Duan L. et al. Vertebral artery ostium atherosclerotic plaque as a potential source of posterior circulation ischemic stroke: result from borgess medical center vertebral artery ostium stenting registry. Stroke 2011; 42: 2544–2549. DOI: 10.1161/STROKEAHA.110.610451. PMID: 21778441.
Chen X., Huang Q., Hong B. et al. Drug-eluting stent for the treatment of symptomatic vertebral origin stenosis: Long-term results. J Clin Neurosci 2011; 18: 47–51. DOI: 10.1016/j.jocn.2010.05.023. PMID: 20888236.
Edgell R., Zaidat O., Gupta R. et al. Multicenter study of safety in stenting for symptomatic vertebral artery origin stenosis: results from the Society of Vascular and Interventional Neurology Research Consortium. J Neuroimaging 2011; 23: 170–174. DOI: 10.1111/j.1552-6569.2011.00665.x. PMID: 22211776.
Fields J., Petersen B., Lutsep H. et al. Drug eluting stents for symptomatic intracranial and vertebral artery stenosis. Interv Neuroradiol 2011; 17: 241–247. DOI: 10.1177/159101991101700217. PMID: 21696666.
Ogilvy C., Yang X., Natarajan S. et al. Restenosis rates following vertebral artery origin stenting: does stent type make a difference? J Invasive Cardiol 2010; 22: 119–124. PMID: 20197579.
Park M., Fiorella D., Stiefel M. et al. Vertebral artery origin stents revisited: improved results with paclitaxel-eluting stents. Neurosurgery 2010; 67: 41–48. PMID: 20568666.
Powers W. Carotid arteriography: still golden after all these years? Neurology 2004; 62: 1246–1247. PMID: 15111656.
Raghuram K., Seynnaeve C., Rai A. Endovascular treatment of extracranial atherosclerotic disease involving the vertebral artery origins: a comparison of drug-eluting and bare-metal stents. J Neurointerv Surg 2012; 4: 206–210. DOI:10.1136/neurintsurg-2011-010051. PMID: 21990510.
Werner M., Braunlich S., Ulrich M. et al. Drug-eluting stents for the treatment of vertebral artery origin stenosis. J Endovasc Ther 2010; 17: 232–240. DOI: 10.1583/09-2904.1. PMID: 20426646.
Matula C., Trattnig S., Tschabitscher M. et al. The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol 1997; 48: 125–131. PMID: 9242236.
Zhou Z., Yin Q., Xu G et al. Influence of vessel size and tortuosity on instent restenosis after stent implantation in the vertebral artery ostium. Cardiovasc Intervent Radiol 2011; 34: 481–487. DOI: 10.1007/s00270-010-9953-4. PMID: 20683721.
Albuquerque F., Fiorella D., Han P. et al. A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery 2003; 53: 607–614. PMID: 12943577.
Chung S., Lee D., Choi J. et al. Use of self-expanding stents for the treatment of vertebral artery ostial stenosis: a single center experience. Korean J Radiol 2010; 11: 156–163. DOI: 10.3348/kjr.2010.11.2.156. PMID: 20191062.
Kim S., Baik M., Yoo S. et al. Stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery origin and treatment with the stentin stent technique. Report of two cases. J Neurosurg 2007; 106: 907–11. DOI: 10.3171/jns.2007.106.5.907. PMID: 17542539.
Tsutsumi M., Kazekawa K., Onizuka M. et al. Stent fracture in revascularization for symptomatic ostial vertebral artery stenosis. Neuroradiology 2007; 49:253–257. DOI: 10.1007/s00234-006-0185-x. PMID: 17151868.
Weber W., Mayer T., Henkes H. et al. Efficacy of stent angioplasty for symptomatic stenoses of the proximal vertebral artery. Eur J Radiol 2005; 56: 240–247. DOI: 10.1016/j.ejrad.2005.05.009. PMID: 15961267.