Symptomatic ostial vertebral artery stenosis treated with tubular coronary stents: clinical results and restenosis analysis.
OBJECTIVE
To evaluate the feasibility and safety of stent implantation to treat ostial vertebral artery stenosis.


METHODS
Fifty-eight symptomatic patients (44 men; mean age 72 years, range 54 to 88) with 67 ostial vertebral artery lesions received 67 balloon-expandable coronary stents. Follow-up angiography was performed if restenosis was suspected or during later catheterization for other indications. Restenosis was defined as >50% diameter narrowing.


RESULTS
Technical success was 100%. Periprocedural neurological complications included 2 (3.4%) posterior and 1 (1.7%) anterior strokes. Other complications included 1 (1.7%) massive gastrointestinal hemorrhage requiring blood transfusion and endoscopic therapy, 1 (1.7%) femoral pseudoaneurysm requiring surgical repair, and 1 (1.7%) large shoulder hematoma secondary to a ruptured small branch of the thoracoacromial artery. Antiplatelet medication was discontinued in the ulcer patient, and the vertebral stent occluded at 8 months. At a mean follow-up of 31.3+/-17.1 months, 1 (1.7%) patient died after coronary bypass 2 months after stenting. One (1.7%) patient reported recurrent dizziness at 14 months and had angiographic evidence of in-stent restenosis. Angiographic evaluation of 32 (48%) lesions at a mean 11.0+/-9.6 months uncovered restenosis in 8 (25%) vessels, including the 2 cases noted above. Aside from these 2 patients, none of the other patients with restenosis were symptomatic. Multivariant Cox regression analysis showed reference vessel diameter as the only independent predictor of restenosis.


CONCLUSIONS
Symptomatic ostial vertebral artery stenosis can be treated with relative safety using coronary techniques and equipment. Reference vessel diameter was the only predictor of restenosis in vertebral artery ostial stents.
Lin
Yen-Hung
YH
Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
Juang
Jyh-Ming
JM
Jeng
Jiann-Shing
JS
Yip
Ping-Keung
PK
Kao
Hsien-Li
HL
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000628:therapy*