Optimization technique for stenting of ostial vertebral artery stenosis

Abstract

Objective ‒ to develop a technique for endovascular treatment of symptomatic ostial stenosis of the vertebral arteries, which allows to minimize risks of delayed stent breakage and restenosis. Materials and methods. This is analysis of prospectively collected data from patients presenting from 2016 to 2019 in the endovascular center of the Dnepropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. One hundred four stents were placed in 99 patients using the author’s complex method, which is based on our modification of Szabo technique. The principles of the method were developed based on a literature review and in vitro tests using 7 silicone models of the initial segments of the subclavian and vertebral arteries with different angles of divergence of the vertebral arteries (30, 45, 60, 90, 120, 135, 150°) and 9 balloon mounted drug-eluting stents with open-cell design Resolute (Medtronic).Results. There were no cases of displacement of the stent proximally or distally during implantation. In all cases, stents were implanted in the affected segment exactly and did not prolapse more than 1 mm beyond the ostium of the vertebral artery into the subclavian artery. There were no «clinical» ischemic complications in the early postoperative period. In 5 cases, isolated subclinical ischemic lessions in the carotid circulation were revealed during one-session stenting of ostial stenosis of the vertebral arteries and carotid stenting. In the posterior circulation, ischemic lessions on MRI in the early postoperative period were not detected in any observations.Conclusions. Developed complex stenting method based on our modification of Szabo technique allows us to achieve optimal long-term results of stenting of symptomatic ostial stenosis of the vertebral arteries.