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  • Endovascular treatment of the vertebral artery origin stenosis by using the closed-cell, self-expandable Carotid Wallstent

    Final Number:
    1440

    Authors:
    Sung-Hoon Kim MD; Chang Hwa Choi MD; Tae Hong Lee

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Endovascular treatment has been considered a good alternative to surgery for symptomatic vertebral artery origin stenosis (VAOS) due to the high morbidity risk associated with surgery.

    Methods: The records of 47 patients with VAOS refractory to adequate medication who were treated by endovascular treatment with the Carotid Wallstent from December 2004 to November 2010 were retrospectively evaluated.

    Results: Of the 47 patients, 37 presented with transient ischemic attacks or stroke. Thirty-one patients (65.9%) manifested other brachiocephalic stenoses; of these, 26 patients had occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Overall technical success (defined as 20% or less residual stenosis) was 100%. Procedure-related complications (n = 6, 12.7%) included sudden asystole (n = 1), acute in-stent thrombosis (n = 2), minor stroke (n = 2), and stent shortening (n = 1). All complications were resolved without permanent neurological deficit. Angiographic follow-up (mean, 9.0 months) was achieved in 32 patients and revealed in-stent restenosis in 1 patient (3.1%) and stent malposition by shortening in 2 patients (6.2%). No stent fracture occurred in any of the patients on follow-up angiography. All patients were neurologically stable at clinical follow-up.

    Conclusions: Endovascular treatment of symptomatic VAOS using the closed-cell, self-expandable Carotid Wallstent is technically feasible and effective in alleviating patient symptoms and for improving vertebrobasilar blood flow.

    Patient Care: It will improve to treat of vertebral artery origin stenosis by using carotid wallstent

    Learning Objectives: To evaluate the feasibility and efficacy of insertion of the closed-cell, self-expandable Carotid Wallstent for treatment of VAOS

    References: 1. Aikawa H, Nagata S, Onizuka M, Tsutsumi M, Iko M, Kodama T et al : Shortening of Wallstent RP during carotid artery stenting requires appropriate stent placement. Neurol Med Chir. 2008 Jun;48(6):249-252 2. Akins PT, Kerber CW, Pakbas RS. Stenting of vertebral artery orgin atherosclerosis in high-risk patients:bare or coated? A single-center consecutive case series. J Invasive Cardiol 2008 Jan;20(1):14-20 3. Albuquerque FC, Fiorella D, Han P, Spetzler RF, McDougall CG. A reappraisal of angioplsty and stenting for the treatment of vertebral origin stenosis. Neurosurgery 2003 Sep;53(3):607-614 4. Biria M, Tadros P, Gupta K. Subclavian-vertebral artery bifurcation stenting using drug-eluting stents: a report of two cases using different techniques. J Invasive Cardiol. 2007 Jun;19(6):E156-159 5. Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry : analysis of 1,000 consecutive patients with first stroke. Stroke 1988 Sep;19(9):1083-1092 6. Boulos AS. Agner C, Deshaies EM. Preliminary evidence supporting the safety of drug-eluing stents in neurovascular disease. Neurol Res 2005;27 Suppl 1:S95-102 7. Caplan LR, Amarenco P, Rosengart A, Lafranchise EF, Teal PA, Belkin M et al. Embolism from vertebral artery origin occlusive disease. Neurology 1992 Aug;42(8):1505-1512 8. Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdela L, Chang HM et al. New England Medical Center Posterior Circulation Registry. Ann Neurol. 2004 Sep;56(3):389-398 9. Cloud GC, Crawley F, Clifton A, McCabe DJ, Brown MM, Markus HS. Vertebral artery origin angioplasty and primary stenting : safety and restenosis rates in a prospective series. J Neurol Neurosurg Psychiatry 2003 May;74(5):586-590 10. Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown NM et al. Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study(CAVATAS) : a randomized trial. Stroke 2007 May;38(5):1526-1530 11. Dabus G, Gerstle RJ, Derdeyn CP, Cross DT 3rd, Moran CJ. Endovascular treatment of the vertebral artery origin in patients with symptoms of vertebrobasilar ischemia. Neuroradiology 2006 Dec;48(12):917-923 12. Ellis SG, Colombo A, Grube E, Popma J, Koglin J, Dawkins KD et al. Incidence, timing, and correlates of stent thrombosis with the polymeric paclitaxel drug-eluting stent: a TAXUS II, IV, V, and VI meta-analysis of 3,445 patients followed for up to 3 years. J Am Coll Cardiol 2007 Mar 13;49(10):1043-1051 13. Hass WK, Fields WS, North RR, Kircheff II, Chase NE, Bauer RB. Joint study of extracranial artery occlusion. II. Arteriography, techniques, sites, and complications. JAMA 1968 Mar 11;203(11):961-968 14. Henry M, Amor M, Klonaris C, Henry I, Masson I, Chati Z et al. Angioplasty and stenting of the extracranial carotid arteries. Tex Heart Inst J 2000;27(2):150-158

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