Vertebral artery origin stents revisited: Improved results with paclitaxel-eluting stents

Min S. Park, David Fiorella, Michael F. Stiefel, Shervin R. Dashti, L. Fernando Gonzalez, Cameron McDougall, Felipe C. Albuquerque

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)41-48
Number of pages8
JournalNeurosurgery
Volume67
Issue number1
DOIs
StatePublished - Jul 1 2010
Externally publishedYes

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Keywords

  • Angioplasty
  • Endovascular
  • Stenosis
  • Stents
  • Vertebral artery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Park, M. S., Fiorella, D., Stiefel, M. F., Dashti, S. R., Gonzalez, L. F., McDougall, C., & Albuquerque, F. C. (2010). Vertebral artery origin stents revisited: Improved results with paclitaxel-eluting stents. Neurosurgery, 67(1), 41-48. https://doi.org/10.1227/01.NEU.0000370010.09419.23