Introduction: The optimal management of patients with symptomatic severe vertebral artery ostium (VAO) stenosis is still unclear. Although stent-assisted angioplasty is thought to be a safe treatment option, the main concerns related to treating VAO stenosis with stents have been the rate of restenosis and the uncertain long-term results. We analyzed the long-term outcome of patients with VAO stenosis who received vertebral artery stenting (VAS).
Methods: One hundred nineteen patients with VAO stenosis were treated with stent placement over a period of 10 years. All patients were retrospectively analyzed. The indication criteria for this treatment were symptomatic severe VAO stenoses (> 60%) and asymptomatic severe VAO stenoses (> 60%) with incidentally detected infarction in the posterior circulation or with severe bilateral VAO stenosis, contralateral VA occlusion, or contralateral hypoplastic VA.
Results: Technical success was 100%. Angiographic evaluation at a mean 12.2 months (range from 3 ~ 68 months) uncovered restenosis in 10 vessels (8.4%; 5 in bare-metal stent group and 5 in drug-eluting stent group) and occlusion in 3 (2.5%; 1 in bare-metal stent group and 2 in drug-eluting stent group). Two patients (1.7%) had recurrent stroke in stented-vessel territories at 3 months with angiographic evidence of in=stent occlusion and 48 months after the procedure, respectively.
Conclusions: VAS can be safely and effectively performed with a low rate of recurrent stroke in the territory of the treated vessel.
Patient Care: In this study, our patients had a very low rate of symptom recurrence after treatment. Therefore, VAS can be safely and effectively performed with a low rate of recurrent stroke in the territory of the treated vessel.
Learning Objectives: By the conclusion of this session, participants should be able to
1)describe the importance of VAO stenosis as a potential source of posterior circulation ischemic stroke.
2)identify the fact that VAO stenting could be an effective treatment for VAO stenosis.
References: 1. Hatano T, Tsukahara T, Miyakoshi A, Arai D, Yamaguchi S, Murakami M. Stent placement for atherosclerotic stenosis of the vertebral artery ostium: angiographic and clinical outcomes in 117 consecutive patients. Neurosurgery. 2011;68(1):108-16
2. Al-Ali F, Barrow T, Duan L, Jefferson A, Louis S, Luke K, Major K, Smoker S, Walker S, Yacobozzi M.
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(9):2544-9.