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Treatment of vertebral artery origin stenosis with a Pharos stent device: a single center experience
E Broussalis1, A B Kunz, G Luthringshausen
1Department of Neurology, Paracelsus Medical University, Christian Doppler Klinik, Salzburg, Austria. e.broussalis@salk.at
Insights
The Pharos stent effectively treats vertebral artery (VA) stenosis, a major cause of stroke. While restenosis occurred in 55% of patients, only 10% required re-treatment, indicating a positive clinical outcome.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Research
Background:
- Vertebral artery (VA) stenosis >70% causes one-third of vertebrobasilar strokes.
- Endovascular treatment is a key therapeutic option for symptomatic VA stenosis.
Purpose of the Study:
- To assess the one-year outcomes of endovascular treatment for VA stenosis using the novel Pharos stent device.
- To evaluate the safety and efficacy of the Pharos stent in preventing cerebrovascular events.
Main Methods:
- Twenty-two patients with symptomatic VA stenosis underwent treatment with the Pharos stent.
- Clinical status and stenosis severity were monitored pre-treatment and at 24 hours, 1, 3, and 12 months post-treatment using ultrasound and MRI.
Main Results:
- All procedures were technically successful with no intra-procedural complications.
- After one year, 55% of patients had a mean stenosis of 60%, with 10% experiencing residual stenosis and 45% developing in-stent restenosis.
- Only two patients (10%) had hemodynamically significant in-stent restenosis (80%) requiring re-treatment; no neurological deterioration was observed.
Conclusions:
- Vertebral artery stenting with the Pharos stent is an effective treatment for stenosis, demonstrating good clinical outcomes.
- Further studies are needed to investigate the high restenosis rates and their impact on clinical outcomes, and to explore factors like collateralization and antiplatelet therapy.
Abstract:
Atherosclerotic stenosis of vertebral artery (VA) origin exceeding 70% severity accounts for one third of all vertebrobasilar strokes. For a period of one year the results of endovascular treatment of VA stenosis with the new Pharos stent device were assessed.Twenty-two patients with symptomatic VA stenosis were treated with the Pharos stent. Clinical status and stenosis grade were documented before treatment and 24 hours, one, three and twelve months after treatment via ultrasound and magnetic resonance tomography.All procedures proved to be technically successful without the occurrence of intra-procedural complications. During the observation period of more than one year, 55% of patients were documented with a mean stenosis degree of 60%: two (10%) of these patients showed a residual stenosis after angioplasty and nine patients (45%) an in-stent restenosis, whereas only two patients were documented with a hemodynamically relevant in-stent restenosis of 80%. These two patients were retreated with balloon dilatation. None of the patients showed neurological deterioration or new abnormalities at magnetic resonance tomography examination. Neither VA occlusion nor restenosis of the contralateral VA negatively affected the clinical outcome. An in-stent restenosis was developed by more female than male patients.VA origin stenting with the Pharos stent device is an effective treatment of stenosis. The good clinical results compared to the high restenosis rates have to be examined in further studies. Pin particular, it has to be determined whether the Pharos stent allows the vessel time for collateralization, whether double antiplatelet treatment prevents recurrent cerebrovascular events or whether merely the low restenosis degree is causative for the clinical outcome.