Treatment Of Vertebral Artery Stenosis Research Articles

Application of color Doppler ultrasound to evaluate and analyze the risk factors of residual stenosis after vertebral artery origin stenting.

Vertebral artery origin stenting (VAOS) is the mainstream method for the treatment of vertebral artery stenosis (VAS). However, there are few studies on the risk factors analysis for residual stenosis after VAOS. This study aimed to apply color Doppler ultrasound (CDU) to evaluate and analyze the risk factors of residual stenosis after VAOS. About 178 patients with VAOS were included from 2017 to 2019 in Liuzhou worker's hospital and divided into the residual stenosis group (n = 38) and the no-residual stenosis group (n = 140). The clinical data and hemodynamics alteration before and after VAOS were collected. The univariate and multivariate logistic regression analysis was used to analyze the risk factors of residual stenosis. Compared with the no-residual stenosis group, the proportion of hypertension, the bending of the initial segment, and the residual stenosis length > 10 mm in the residual stenosis group were significantly higher, while the original internal diameter was significantly smaller (P < 0.05). The multivariate logistic regression analysis showed that the bending of initial segment (OR = 2.41, 95% CI: 1.32-5.45, P = 0.033), the original internal diameter (OR = 2.29, 95% CI: 1.13-5.66, P = 0.001), and the residual stenosis length > 10 mm were the risk factors of residual stenosis (OR = 2.78, 95% CI: 1.82-5.85, P = 0.044). The bending of initial segment, the original internal diameter, and the residual stenosis length > 10 mm were the risk factors of residual stenosis after VAOS.

Evaluation of Clinical and Radiological Results of the Perioperative and Postoperative Periods in the Endovascular Treatment of Vertebral Artery Stenosis

Evaluation of Clinical and Radiological Results of the Perioperative and Postoperative Periods in the Endovascular Treatment of Vertebral Artery Stenosis

Safety and Efficacy of Rapamycin-Eluting Vertebral Stents in Patients With Symptomatic Extracranial Vertebral Artery Stenosis

Background and Purpose: Drug-eluting stents generally have superior performance to bare metal stents in the treatment of vertebral artery stenosis (VAS). This prospective, multicenter, and single-arm clinical trial was initiated to assess in-stent restenosis (ISR) and midterm outcome after rapamycin-eluting stent placement in patients with symptomatic extracranial VAS.Methods: The subjects underwent angiographic follow-up at 6 months and final clinical follow-up at 12 months. The primary efficacy endpoint was ISR at 6 months. Secondary endpoints included technical success, target lesion-related transient ischemic attack (TIA), stroke, or death, and all-cause TIA, stroke, or death during the 12-month follow-up period.Results: A total of 104 stents were implanted in the 101 patients and 83 patients (82.2%) completed angiographic follow-up at 6 months. The technical success rate was 86.1% (87/101); mean in-stent stenosis rate was 25.1 ± 17.1% and ISR rate was 5.9% (95% CI: 0.8–10.9%). All the patients with ISR were completely asymptomatic and no stent fractures were observed during angiographic follow-up. At the 12-month clinical follow-up, target lesion-related TIA, stroke, or death had occurred in two (2.0%) patients and all-cause TIA, stroke, or death had occurred in six (6.1%) patients.Conclusion: The placement of rapamycin-eluting stents in patients with symptomatic extracranial VAS yields favorable ISR results and showed a trend of favorable safety outcomes including low rates of perioperative complications and late stroke. However, further study is needed to establish the long-term clinical benefits of this stent in the treatment of VA disease.

Surgical Treatment of Vertebral Artery Stenosis: An Overlooked Surgery with Low Morbidity

Vertebral artery (VA) stenosis as a cause of ischemic events and its surgical treatment is an overlooked subject. After reporting our initial results, the results of VA stenosis operations and the follow-up studies are analyzed. This retrospective, single-center study includes 43 symptomatic proximal VA stenosis patients between September 2012 and March 2019. The demographics and clinical data were obtained from the hospital records. Doppler ultrasonography and computed tomography angiography were used to establish the diagnosis and for follow-up. The surgical procedures were as follows: VA transposition in 30 (69.8%), VA bypass 8 (18.6%), saphenous vein interposition in VA in 4 (9.3%), and decompression of kinking in 1 (2.3%) patient. Eleven patients (25.5%) had concomitant carotid surgery. The Kaplan-Meier method was used to calculate the survival and patency rates. Most common symptoms were vertigo and loss of balance in 38 (88.4%) and 14 (32.6%) patients, respectively. Twenty-five patients were males (58.1%), and the average age was 64.6±9.8 (50-90) years. The 30-day death, 30-day stroke, and 30-day death/stroke rates were 2.3%, 4.7%, and 7%, respectively. Ten patients (23.3%) had morbidities which were related to the intervention. Horner syndrome was found in 5 (11.6%) patients, and facial nerve injury was found in one (2.3%) patient. Three (7.1%) patients died during the follow-up period, and overall survival of the patients at 3years was 91.4%±5.8%. Two (4.7%) patients had cerebrovascular events (CVEs) occurred during the follow-up. One- and three-year CVE-free survivals were 97.1%±2.9% and 90.1%±7.2%, respectively. Two patients (5.4%) had restenosis. One- and three-year patency of VA after procedure was 89.1%±7.4%. Thirty-seven (86%) patients had complete recovery of symptoms after surgery; 5 patients (11.6%) kept their preoperative symptoms in different levels. Vertebral artery surgery can be performed with acceptable mortality and morbidity rates. Restenosis-free, CVE-free, and overall survival rates are satisfactory.

Vertebral-carotid transposition can treat various diseases

Vertebral-carotid transposition (VCT), which is a treatment of vertebral artery stenosis, has excellent long-term efficacy. VCT can also be suitable for various situations where the blood supply of the vertebral artery must be reconstructed. Here, we present an early result of six cases for these anomalies by VCT. Case 1: A 58-year-old male presented with the severe stenosis at the left vertebral V1 segment. Case 2: A 59-year-old female suffered from moderate-to-severe stenosis at the first portion of the left subclavian artery. Case 3: A 55-year-old female experienced severe stenosis at the left vertebral V1 segment, which the wire could not pass through. Case 4: A 53-year-old female presented with the subclavian aneurysm at the origin of the right vertebral artery. Case 5: A 65-year-old male suffered from the long complete occlusion at the origin of the left subclavian artery, a severe stenosis at the origin of the left internal carotid artery, a severe stenosis at the origin of the right internal carotid artery, and a severe stenosis at the right vertebral V1 segment. Case 6: A 56-year-old male experienced the thrombus in the stent of the vertebral artery which had been placed 6 months ago. There are six cases, in which VCT was adapted. VCT is safe and effective for various situations when the blood supply of the vertebral artery must be reconstructed.

Endovascular treatment of symptomatic severe vertebral artery stenosis

About 25%-40% of ischemic stroke is in the posterior circulation, in which 20% of posterior circulation stroke is caused by vertebral artery stenosis. Patients with symptomatic vertebral artery stenosis have a high risk of recurrent stroke. At present, the treatments of vertebral artery stenosis include medication, open surgery and interventional therapy. In this paper, the endovascular treatment of vertebral artery stenosis is reviewed, especially the progress of endovascular treatment is expounded, in order to promote the development of its treatment. Key words: Brain ischemia; Vertebral artery stenosis; Angioplasty, balloon; Drug-eluting stents; Atherectomy

Surgical Treatment of Vertebral Artery Stenosis: An Overlooked Surgery with Low Morbidity

Introduction: Vertebral artery stenosis (VAS) as a cause of ischemic events and its surgical treatment is an overlooked subject. After reporting our initial results [1], the outcome results of VAS operations and the follow-up are analyzed. Methods: Forty three patients were operated for VAS. Most common symptoms were vertigo and loss of balance in 38 (88.4%) and 14 (32.6%) patients, respectively. Dyslipidemia was present in 39 (90.7%) patients. Twenty five were male (58.1%) and the average age was 64.6±9.8 (50-90) years. During surgical operation, vertebral artery exploration was commenced from as distal as possible after transecting the scalene anterior muscle in order to avoid damage to the sympathetic ganglia. The procedures were as follows: VA transposition in 30 (69.8%), VA bypass 8 (18.6%), saphenous vein interposition in VA in 4 (9.3%) and decompression of kinking in 1 (2.3%) patients. Twenty seven procedures (62.8%) were performed on the left and 16 (37.2%) on the right side. Ipsilateral carotid disease was present in 25 (58.1%) cases and 11 of them had concomitant carotid surgery. Of these, 9 had bilateral disease. Results: One (2.3%) mortality occurred. Ten patients (23.3%) had morbidities which were related to the intervention. Horner syndrome occurred in 5 (11.6%) patients. Average durations of intensive care and hospital stays were 1.7±2.1 (1-11) and 6.0±6.7 (3-32) days, respectively. Average duration of follow-up was 22.3±22.0 (0.1-71.6) months (total 79.8 patient/years). Two patients (4.7%) had cerebrovascular events (CVE) occurred during the follow-up (one in the 48th day and the other after 2.3 years later). CVE-free survival was 1.8±1.8 years in average. Five patients (11.6%) had short-termed symptoms during follow-up. Thirty seven patients (86.0%) had CT angiography during follow-up. The CT angiography follow-up duration in average was 17.1±20.6 (0.1-69.8) months with a total of 52.7 years. Two patients (5.4%) had restenosis. Restenosis-free survival was 15.5±20.4 (0.1-69.8) months (total 49.0 patient/years) (Figure 1). One-year patency of VA after procedure was 89.1%±7.4%. One and three years CVE-free survivals were 97.1%±2.9% and 90.1%±7.2%, respectively (Figure 2). Overall survival of the patients at 2 and 5 years were 91.4%±5.8% and 83.8%±9.0%, respectively (Figure 3). Conclusion: Vertebral artery surgery can be performed with acceptable mortality and morbidity rates. Minor modifications in surgical exposure will avoid Horner's syndrome and many other surgical complications. Restenosis-free, CVE-free and overall survival rates are satisfactory. Disclosure: None to disclose

Cerebrovascular Drug-Eluting Stent versus Bare-Metal Stent in the Treatment of Vertebral Artery Stenosis: A Non-Inferiority Randomized Clinical Trial.

Cerebrovascular Drug-Eluting Stent versus Bare-Metal Stent in the Treatment of Vertebral Artery Stenosis: A Non-Inferiority Randomized Clinical Trial.

Angioplasty and drug-eluting stent for vertebral artery stenosis

Objective To study the efficacy, safety, and feasibility of angioplasty and drug-eluting stents (DESs) in the treatment of vertebral artery stenosis. Patients and methods The study was carried out on 20 patients (17 patients with vertebral artery endovascular stenting and three patients with angioplasty alone). The success rate, perioperative complications, and long-term effectiveness were evaluated. Results A total of 17 DESs were implanted and three patients with angioplasty alone. The success rate was 100%. The degree of stenosis decreased from 78.25±10.17 to 11.50±7.45% (P Conclusion Angioplasty and DESs is a safe and effective strategy for the treatment of symptomatic vertebral artery stenosis.

Balloon-expandable stent angioplasty in the treatment of vertebral artery stenosis in the V2 segment.

IntroductionVertebral artery stenosis is a major cause of posterior circulation ischemia in the elderly. There is not a clear consensus on the optimal therapeutic approach for symptomatic extracranial vertebral artery stenosis.AimTo evaluate the feasibility and efficacy of balloon-expandable stent angioplasty in the treatment of vertebral artery stenosis in the V2 segment.Material and methodsFive patients with vertebral artery stenosis (V2 segment) and treatment of percutaneous transluminal stenting from July 2009 to June 2014 were retrospectively evaluated. All patients underwent color Doppler, transcranial color Doppler (TCD), CT angiography (CTA) and cerebral digital subtraction angiography (DSA) preoperatively. Whether there was osseous oppression was determined according to neck computed tomography (CT) and CTA. After the surgery, angiography was performed to determine if there was infarction or bleeding in the intracranial vertebral artery, basilar artery and posterior cerebral artery. The surgical parameters, residual stenosis, complications, etc. were recorded and evaluated. The patients were followed up accordingly.ResultsFive patients (3 males, 2 females; average age of 66 ±4.2, range of 54–75) were enrolled in the study. Balloon-expandable stents were successfully implanted in the 5 patients. The mean residual stenosis after the balloon-expandable stenting (preoperative: average, 87.0 ±6.6%, range: 75–93%) was 12.6 ±7.8% (range: 5–25%). The clinical symptoms disappeared or receded. No serious complications occurred.ConclusionsThe balloon-expandable stent angioplasty seemed to be feasible and efficacious in treating vertebral artery stenosis in the V2 segment. Further study with a large sample size is needed.

Treatment of proximal segment stenoses of vertebral arteries with baloon expandable silicon carbide coated stents

Background: Untreated atherosclerotic stenotic lesions of the vertebral arteries may result in signs of vertebro-basilar syndrome, transient ischemic attacks or a permanent neurologic deficit of the brainstem and cerebellum. Stenting of the vertebral artery origin (V1 segment), most frequently involved part of the artery, represents a newer treatment option in the endovascular management of occlusive atherosclerotic vascular disease in the posterior circulation. The method is more effective than percutaneous angioplasty, due to a lower restenosis rate. Material and methods: With respect to the trial inclusion criteria, we treated 23 patients with symptoms of vertebro-basilar syndrome due to hemodynamically significant stenosis of V1 segment. The patients included in the study were treated from April 2009 until August 2011. Diagnostic workout and control angiography were performed by multislice computed tomography angiography of both vertebral and basilar artery. The lesions were treated with balloon expandable, silicon carbide coated nitinol stents. All patients received continuous antithrombotic and anticoagulant protection with acetylsalicylic acid and clopidogrel before and after the procedure. All patients underwent control neurological and CT angiography examination six to twelve months after the procedure. Results: In the treated patients, the degree of stenosis of dominant vertebral artery ranged from 50 % to 93 %. Stenting was performed in all patients without distal filter protection. There were no peri-procedural adverse events. Control CT angiography showed one stent occlusion and one greater hemodynamically significant restenosis over 50 %, other stents we patent. None of the patients, not even those with occluded stents, presented with worsening of symptoms or a worse outcome on the Ranking scale at the time of control neurological examination. Conclusions: Stenting of the vertebral arteries can significantly improve hemodynamic conditions in the posterior circulation and prevent recurrent transient ischemic attacks and worsening of vertebro-basilar symptoms. So far, less than twenty studies have been published on the stenting of vertebral arteries worldwide. Randomized larger prospective trials are needed to confirm the benefit of endovascular treatment of vertebral artery stenosis, also by use of drugeluting stents.

Endovascular treatment of vertebral artery stenosis

The safest and most effective treatment for symptomatic vertebral artery stenosis has not yet been proven. Here, we discuss the merits and pitfalls of endovascular treatment for this under-recognized disease entity.

Endovascular Treatment of Isolated PICA Insufficiency

The vertebral artery terminating in the posterior inferior cerebellar artery is rare but it may cause cerebellar infarction when total occlusion of the vertebral artery occurs. Therefore treatment of vertebral artery stenosis in these patients is crucial. Surgical treatment of osteal vertebral artery stenosis is possible but is associated with approximately 4% mortality and up to 20% risk of procedural complications including perioperative VA occlusion, Horner syndrome, lymphatic injury and injury to the phrenic, vagus, laryngeal and thoracic nerves. Therefore percutaneous angioplasty with or without stent placement is emerging as an alternative treatment method with a high success rate and good initial angiographic outcome. Percutaneous angioplasty of the VA origin is associated with an approximately 15% restenosis rate. Stent placement is believed to decrease the incidence of elastic recoil and restenosis. Herein we present a rare symptomatic case with an anomalous, small-caliber right VA terminating in the PICA which was successfully treated with a drug-eluting stent.

椎骨動脈転位術を施行した椎骨動脈狭窄症 2 例の検討

椎骨動脈転位術を施行した椎骨動脈狭窄症 2 例の検討

Long-Term Outcome After Angioplasty and Stenting for Symptomatic Vertebral Artery Stenosis Compared With Medical Treatment in the C arotid A nd V ertebral A rtery T ransluminal A ngioplasty S tudy (CAVATAS)

The long-term outcome of endovascular intervention compared with best medical management of patients with symptomatic vertebral artery stenosis is uncertain. We therefore compared these treatments in a randomized trial with long-term follow-up. In the international, multicenter Carotid And Vertebral Artery Transluminal Angioplasty Study, 16 patients with symptomatic vertebral artery stenosis were randomized in equal proportions to receive endovascular therapy (balloon angioplasty or stenting) or best medical treatment alone. An independent neurologist followed up the patients for as long as 8 years. Endovascular intervention was technically successful in all 8 patients, but 2 patients experienced transient ischemic attack at the time of endovascular treatment. There were no deaths or strokes in any arterial territory within the first 30 days. During a mean follow-up period of 4.7 years, no patient in either treatment group experienced a vertebrobasilar territory stroke, but 3 patients in each treatment arm died of myocardial infarction or carotid territory stroke, and 1 endovascular patient had a nonfatal carotid territory stroke. Patients with vertebral artery stenosis were more likely to have carotid territory stroke and myocardial infarction during follow-up than have recurrent vertebrobasilar stroke. The trial failed to show a benefit of endovascular treatment of vertebral artery stenosis, but the numbers of patients included was small. Larger randomized trials are required to determine whether vertebral artery stenting is justified in patients at higher risk of vertebrobasilar stroke. Treatment of patients with vertebral artery stenosis should focus on global reduction of vascular risk, including prevention of carotid territory stroke and myocardial infarction.

Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis

Surgery for vertebral artery stenosis is technically difficult, potentially hazardous and is not considered in most centres. There is growing evidence from case series that vertebral artery stenosis may be treated endovascularly by percutaneous transluminal angioplasty and stenting. This may be a feasible alternative to surgery to relieve symptoms caused by significant stenosis. The objective of this review was to assess the safety and efficacy of vertebral artery percutaneous transluminal angioplasty, with or without stenting, combined with medical care, compared to medical care alone, in patients with vertebral artery stenosis. We searched the Cochrane Stroke Group's trials register (last searched 28 July 2004). In addition we searched the following bibliographic databases: Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2002), MEDLINE (1966 to July 2004), EMBASE (1980 to July 2004), and Science Citation Index (1981 to July 2004). We also contacted researchers in the field, and balloon catheter and stent manufacturers. We selected randomised trials of endovascular treatment of vertebral artery stenosis combined with best medical therapy, compared with best medical therapy alone, in patients with symptomatic or asymptomatic vertebral artery stenosis. Two reviewers independently applied the inclusion criteria, extracted data and assessed trial quality. One completed randomised trial was found. In one subgroup of this trial, 16 patients with symptomatic severe vertebral artery stenosis were randomised to endovascular treatment (n = 8) or medical treatment alone (n = 8). There were no strokes in any arterial territory or deaths from any cause in either group within 30 days of treatment (endovascular group) or 30 days of randomisation (medical group). In the endovascular group, two patients had a posterior circulation TIA at the time of the procedure. In the endovascular group, the mean vessel stenosis at follow up was 47% (range 0% to 80%). Patients were followed up for a mean of 4.5 years in the endovascular group and 4.9 years in the medical group. There were no further vertebrobasilar territory strokes in either group for the duration of follow up. Morbidity and mortality was related to carotid and coronary artery disease in this study. There is currently insufficient evidence to assess the effects of percutaneous transluminal angioplasty with or without stenting or primary stenting for vertebral artery stenosis.

Endovascular Treatment for Vertebrobasilar Insufficiency.

Endovascular management of supra-aortic atherosclerotic vascular disease is becoming relatively common in the innominate, subclavian, and carotid arteries. However, revascularization of vertebral artery disease is an infrequently used treatment option due to several reasons: 1) stroke etiology and prevention is generally considered with respect to carotid disease as posterior circulation ischemia is poorly defined; 2) the limited success and excessive morbidity have made surgery an unattractive option for vertebral artery revascularization; 3) routine screening for posterior circulation disease as an etiology for stroke is rarely performed; and 4) endovascular treatment of vertebrobasilar insufficiency is not routinely performed in peripheral interventional programs. Randomized data comparing medical therapy, endovascular treatment, or surgical treatment do not exist. Due to infrequent identification of vertebral artery disease as the etiology of posterior circulation symptomatology, randomized comparisons will be difficult to obtain. Balloon angioplasty alone, provisional stenting, or primary stent placement for the treatment of vertebral artery stenosis is associated with low restenosis rates and high success rates. The available literature demonstrates angioplasty with stent placement of posterior circulation, symptomatic, vertebrobasilar atherosclerotic disease is a safe and effective approach that avoids the morbidity associated with major surgery. We believe primary stent placement is the treatment of choice for vertebral artery revascularization due to the high technical success rate, low incidence of morbidity and mortality, and long-term durability.

Autoperfusion balloon catheter for treatment of vertebral artery stenosis

Percutaneous transluminal angioplasty (PTA) of the vertebral artery was performed with an autoperfusion balloon catheter in five patients. There were no complications in the form of embolic episodes or neurological deficits due to brain ischaemia during inflation. In critical cases with insufficient collateral circulation during temporary occlusion, the use of an autoperfusion balloon catheter may expand the indications for PTA in patients with ischaemic cerebrovascular disease.

Autoperfusion balloon catheter for treatment of vertebral artery stenosis

Autoperfusion balloon catheter for treatment of vertebral artery stenosis