TY - JOUR
T1 - Vertebral artery origin stents revisited
T2 - Improved results with paclitaxel-eluting stents
AU - Park, Min S.
AU - Fiorella, David
AU - Stiefel, Michael F.
AU - Dashti, Shervin R.
AU - Gonzalez, L. Fernando
AU - McDougall, Cameron G.
AU - Albuquerque, Felipe C.
PY - 2010/7/1
Y1 - 2010/7/1
N2 - BACKGROUND: Vertebral origin angioplasty and stenting (VOAS) with bare metal stents is associated with a high rate of in-stent restenosis (ISR). OBJECTIVE: We evaluated the rate of ISR after VOAS with drug-eluting stents. METHODS: Twenty patients (15 men, 5 women; age range, 36-88 years; mean, 63.7 years) were treated for VOAS with a paclitaxel-eluting stent (Taxus Express2, Boston Scientific, Natick, Massachusetts). Stenosis at follow-up was quantified as insignificant (0%-24%), mild (25%-49%), moderate (50%-74%), and severe (75%-100%). ISR was defined using a binary criteria of > 50% stenosis at follow-up angiography. RESULTS: All procedures were technically successful with no periprocedural complications. Follow-up angiography (range, 4-48 months; mean, 14.7 months) showed insignificant stenosis in 9 patients, mild in 6, moderate in 4, and severe in 1. In 1 patient with "moderate" stenosis, the stent migrated distally; therefore, the lesion restenosis was not within the stent. Thus, 4 of 19 patients (21%) exhibited binary moderate or severe ISR, and 5 of 20 showed restenosis at the lesion (25%). The patient with severe stenosis developed stent thrombisis > 3 years after VOAS. CONCLUSION: VOAS with drug-eluting stents was associated with a low incidence of periprocedural complications. Although the rate of restenosis was half that seen with the use of bare metallic stents, 21% of patients still developed moderate or severe ISR. These patients may require ≥ 1 revascularization procedures. The risk of delayed stent thrombosis may necessitate lifelong dual antiplatelet medications.
AB - BACKGROUND: Vertebral origin angioplasty and stenting (VOAS) with bare metal stents is associated with a high rate of in-stent restenosis (ISR). OBJECTIVE: We evaluated the rate of ISR after VOAS with drug-eluting stents. METHODS: Twenty patients (15 men, 5 women; age range, 36-88 years; mean, 63.7 years) were treated for VOAS with a paclitaxel-eluting stent (Taxus Express2, Boston Scientific, Natick, Massachusetts). Stenosis at follow-up was quantified as insignificant (0%-24%), mild (25%-49%), moderate (50%-74%), and severe (75%-100%). ISR was defined using a binary criteria of > 50% stenosis at follow-up angiography. RESULTS: All procedures were technically successful with no periprocedural complications. Follow-up angiography (range, 4-48 months; mean, 14.7 months) showed insignificant stenosis in 9 patients, mild in 6, moderate in 4, and severe in 1. In 1 patient with "moderate" stenosis, the stent migrated distally; therefore, the lesion restenosis was not within the stent. Thus, 4 of 19 patients (21%) exhibited binary moderate or severe ISR, and 5 of 20 showed restenosis at the lesion (25%). The patient with severe stenosis developed stent thrombisis > 3 years after VOAS. CONCLUSION: VOAS with drug-eluting stents was associated with a low incidence of periprocedural complications. Although the rate of restenosis was half that seen with the use of bare metallic stents, 21% of patients still developed moderate or severe ISR. These patients may require ≥ 1 revascularization procedures. The risk of delayed stent thrombosis may necessitate lifelong dual antiplatelet medications.
KW - Angioplasty
KW - Endovascular
KW - Stenosis
KW - Stents
KW - Vertebral artery
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U2 - 10.1227/01.NEU.0000370010.09419.23
DO - 10.1227/01.NEU.0000370010.09419.23
M3 - Article
C2 - 20568666
AN - SCOPUS:77954143413
SN - 0148-396X
VL - 67
SP - 41
EP - 48
JO - Neurosurgery
JF - Neurosurgery
IS - 1
ER -