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Published on: October 20, 2017
Endovascular treatment of symptomatic high-grade vertebral artery stenosis
Djordje Radak1, Srdjan Babic2, Dragan Sagic1
1Institute for Cardiovascular Disease "Dedinje", Belgrade, Serbia; Belgrade University School of Medicine, Belgrade, Serbia.
Insights
Endovascular treatment (EVT) for symptomatic vertebral artery stenosis is safe and effective, showing good initial and long-term results. This procedure achieved high success rates with low complications, even without cerebral protection.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Endovascular Interventions
Background:
- Symptomatic high-grade extracranial vertebral artery (VA) stenosis poses a significant risk.
- Endovascular treatment (EVT) is an emerging option for managing VA stenosis.
Purpose of the Study:
- To evaluate the initial and long-term outcomes of EVT for symptomatic high-grade VA origin stenosis.
- To assess the safety and efficacy of EVT in this patient population.
Main Methods:
- A cohort of 73 patients with symptomatic high-grade VA stenosis underwent EVT between 2001 and 2013.
- Preoperative assessment included Duplex ultrasonography and arteriography.
- Follow-up was conducted at regular intervals post-procedure, with a mean follow-up of 44.3 months.
Main Results:
- Successful EVT was achieved in 93.2% of patients, with no in-hospital deaths.
- The early complication rate was 5.5%, including transient ischemic attack and local hematomas.
- Long-term primary patency rates remained high (87.3% at 7 years), with 10.3% experiencing restenosis.
Conclusions:
- EVT is a safe and effective treatment for symptomatic VA origin stenosis.
- The procedure demonstrates favorable long-term patency and a low complication profile.
- Cerebral protection devices were not required, further supporting the safety of EVT.
Background:
The purpose of this study was to evaluate the initial and long-term results of endovascular treatment (EVT) in patients with symptomatic high-grade extracranial vertebral artery (VA) origin stenosis.
Methods:
From February 2001 to March 2013, 73 consecutive patients (33 men with a mean age of 61.7 ± 8.8 years) underwent EVT for symptomatic high-grade VA stenosis. Preoperative evaluation included Duplex ultrasonography and arteriography. After successful treatment, all patients were followed up at 1, 3, 6, and 12 months after the procedure and every 6 months thereafter.
Results:
Successful EVT of the VA stenosis was achieved in 68 patients (93.2%). All procedures were performed without use of cerebral protection. The early complication rate was 5.5%, which included one periprocedural transient ischemic attack, two hematomas at the puncture site, and one allergic reaction to the contrast agent. No in-hospital deaths occurred. During follow-up (mean, 44.3 ± 31.2 months; range, 2-144 months), the primary patency rates at 1, 3, 5, and 7 years were 98.4%, 87.3%, 87.3%, and 87.3%, respectively. Ultrasound Doppler controls during follow-up detected seven VA restenoses (10.3%). Univariate analysis failed to identify any variable predictive of long-term patency of successfully treated VA stenosis.
Conclusions:
EVT of symptomatic VA origin stenosis is a safe and effective procedure associated with low risk and good long-term results, even without use of cerebral protection devices.
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