title: Vertebral artery origin angioplasty and primary stenting: safety and restenosis rates in a prospective series.
abstract: OBJECTIVE
  To report a single centre ongoing experience of endovascular treatment for atherosclerotic vertebral artery origin stenosis in a series of symptomatic patients, with follow up imaging to determine the incidence of restenosis.
  
  
  METHODS
  14 patients with vertebral artery origin stenosis on catheter angiography were treated. Angioplasty without stenting was undertaken in the first four patients, all of whom had follow up catheter angiography at one year. Subsequently, patients were treated by primary stenting and followed up with colour Doppler ultrasound examination.
  
  
  RESULTS
  The procedure was technically successful in all treated arteries, with no immediate complications. The degree of stenosis was reduced from (mean (SD)) 73 (18)% before treatment to 21 (26)% immediately after treatment in the angioplasty alone group (p = 0.059). In the primary stenting patients, the severity of stenosis was reduced from 82 (8)% to 13 (13)% immediately after treatment (p < 0.001). Restenosis to 70% or greater occurred at one year in all four patients initially treated by angioplasty without stenting. One patient subsequently developed further symptoms and was retreated by stenting. One of the 10 patients treated by primary stenting developed restenosis. None of the remaining patients had further posterior circulation ischaemic symptoms during a mean follow up period of 33.6 months (range 1 to 72 months).
  
  
  CONCLUSIONS
  Restenosis occurs often after vertebral artery origin balloon angioplasty without stenting but is uncommon after stenting. Primary stenting is therefore recommended to maintain patency at this site, and had a low complication rate in this series.
authors.affiliation: Division of Clinical Neuroscience, St George's Hospital Medical School, London SW17 0RE, UK.
authors.forename: G C
authors.initials: GC
authors.lastname: Cloud
authors.forename: F
authors.initials: F
authors.lastname: Crawley
authors.forename: A
authors.initials: A
authors.lastname: Clifton
authors.forename: D J H
authors.initials: DJ
authors.lastname: McCabe
authors.forename: M M
authors.initials: MM
authors.lastname: Brown
authors.forename: H S
authors.initials: HS
authors.lastname: Markus
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*