title: Stenting of symptomatic vertebral artery ostium stenosis with self-expanding stents.
abstract: Symptomatic vertebral arterial stenosis carries a stroke risk of 30% at 5 years. The efficacy of stenting with balloon-expandable stents remains questionable due to a high long-term restenosis rate. This study aimed to investigate the feasibility and efficacy of using self-expanding stents to treat symptomatic vertebral artery ostium (VAO) stenosis in selected patients. Clinical and angiographic results were retrospectively reviewed in patients with symptomatic VAO stenosis who underwent stenting with self-expanding stents between June 2008 and December 2011. In total, 32 patients were included. Self-expanding stents (25 tapered and seven non-tapered) were deployed with a modified technique of deploying the stents from the V1 segment to the proximal subclavian artery. The mean degree of stenosis before and after stenting declined from 76.4% to 11.4%. No peri-procedural complications occurred. During the mean clinical follow-up of 18.3 months, no vertebrobasilar stroke, transient ischemic attack or death occurred. During the mean angiographic follow-up of 12.5 months, asymptomatic restenosis occurred in one (3.1%) patient 6 months after the procedure. No stent fracture occurred. The involved subclavian artery was patent and no clinically apparent events occurred in the dependent upper extremity. Stenting with self-expanding stents for symptomatic VAO stenosis is technically feasible and safe, with reduced restenosis and stent fracture rates in selected patients. Long-term investigations are warranted to validate its performance.
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China.
authors.forename: Zifu
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Neurology, Changhai Hospital, Second Military Medical University, Department of Neurosurgery, Shanghai, China.
authors.forename: Yongwei
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Hong
authors.affiliation: Department of Neurology, Changhai Hospital, Second Military Medical University, Department of Neurosurgery, Shanghai, China.
authors.forename: Benqiang
authors.initials: B
authors.lastname: Deng
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China.
authors.forename: Wenyuan
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China. Electronic address: chstroke@163.com.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China.
authors.forename: Qinghai
authors.initials: Q
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*
keywords: Self-expanding stent; Stenosis; Stenting; Vertebral artery ostium