Percutaneous interventional treatment of extracranial vertebral artery stenosis with coronary stents.
Stenosis of extracranial vertebral artery (VA) is not an infrequent lesion, and it can pose a significant clinical problem. However, the standard treatment for a significant VA stenosis has still not been established. Here in this study, we report our experiences of VA stenting in 25 patients (age 56.2 +/- 15.2 years, male 76%). The patients had comorbidities as follows: DM (36%), hypertension (64%), Takayasu's (12%) and Behcet's diseases (4%). There were combined involvement of other vessels such as the coronary artery (72%), carotid artery (36%), subclavian artery (32%) and the contralateral vertebral artery (24%). Indications for stenting were prior stroke or symptoms related to vertebrobasilar ischemia in 11 patients, and an asymptomatic but angiographically significant stenosis (> 70% stenosis) in 14 patients. Twenty-three balloon-expandable stents and two self-expandable stents were deployed. A drug-eluting coronary stent and distal balloon protection device were each used in one case. A technically successful procedure was achieved in all patients. The baseline reference diameter was 4.7 +/- 1.3 mm, minimal luminal diameter (MLD) 1.0 +/- 0.6 mm (diameter stenosis 77.8 +/- 12.5%) and lesion length 6.4 +/- 3.9 mm. After stenting and adjuvant dilation, the MLD was increased to 4.5 +/- 0.9 mm (diameter stenosis 3.1 +/- 17.9%). There were no procedure-related complications. During the further follow-up period of 25 (3-49) months, no stroke or death occurred. Restenosis was observed in 4 (30.8%) of 13 eligible patients. In conclusion, VA stenting is feasible with a high degree of technical success, and this treatment is associated with a relatively low incidence of procedure-related complications. However, a relative high rate of in-stent restenosis remains as a problem to be resolved.
Ko
Young-Guk
YG
Cardiology Division, Yonsei Cardiovascular Center, Research Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun- gu, Seoul 120-752, Korea.
Park
Sungha
S
Kim
Jong-Youn
JY
Min
Pil-Ki
PK
Choi
Eui-Young
EY
Jung
Jae-Hun
JH
Joung
Boyoung
B
Choi
Donghoon
D
Jang
Yangsoo
Y
Shim
Won-Heum
WH
D000328:Adult; D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000628:therapy*