Treatment of stenoses of vertebral artery origin using short drug-eluting coronary stents: improved follow-up results.
OBJECTIVE
Recent studies on stent placement of significant stenoses at the origin of the vertebral artery reported excellent immediate results. Long-term outcomes, however, were disappointing due to high restenosis rates and stent breakage. In the present study, we evaluated the application of a short drug-eluting balloon-expandable coronary stent for the endovascular treatment of these frequent lesions.


METHODS
In a period of 23 months, 48 patients (12 women, 36 men) with a mean age of 68 years (range, 46-82 years) harboring 52 significant ostial vertebral artery stenoses underwent treatment with short (8 mm) balloon-expandable paclitaxel-eluting coronary stents. Stents were deployed as closely as possible so that the proximal end was just at the origin of the vertebral artery, with high inflation pressure applied. Patients were under continuous medication with acetylsalicylic acid and clopidogrel before and after the treatment. Follow-up clinical assessment and angiography were performed in all patients.


RESULTS
Periprocedural complications were not encountered. Stenosis severity was reduced from 62 +/- 2% (mean +/- standard error of the mean) preprocedurally to 15 +/- 2% postprocedurally. Follow-up angiography at 7.7 +/- 0.6 months revealed a mean stenosis degree of 24 +/- 3%. None of the patients developed posterior circulation symptoms related to the treated segment during the follow-up period. Recurrent stenosis (>50%) at follow-up was found in 6 (12%) lesions.


CONCLUSIONS
Stent placement of significant ostial vertebral artery stenosis by using short drug-eluting stents is safe and yields good midterm patency rates and excellent protection from posterior circulation ischemia.
Vajda
Z
Z
Clinic for Neuroradiology, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany. vajdus@indamail.hu
Miloslavski
E
E
Güthe
T
T
Fischer
S
S
Albes
G
G
Heuschmid
A
A
Henkes
H
H
D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D003331:Coronary Vessels; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D011859:Radiography; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*
D050257:Tubulin Modulators; D017239:Paclitaxel