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[Effect of stenting for the proximal atherosclerotic extracranial vertebral artery stenosis]
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Stenting for atherosclerotic extracranial vertebral artery stenosis is safe and effective, showing good long-term patency rates. Further trials are needed to confirm these findings in a larger patient cohort.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Proximal atherosclerotic extracranial vertebral artery stenosis poses a risk for stroke.
- Endovascular treatment options are being explored for this condition.
Purpose of the Study:
- To evaluate the safety and efficacy of stenting for proximal atherosclerotic extracranial vertebral artery stenosis.
- To assess the technical success and long-term outcomes of this procedure.
Main Methods:
- Prospective enrollment of 204 patients with proximal atherosclerotic extracranial vertebral artery stenosis undergoing stent implantation.
- Data collection through medical records and outpatient/telephone follow-up.
- Assessment of technical success, procedural complications, and long-term patency rates.
Main Results:
- Technical success rate was 100% with significant reduction in stenosis.
- Peri-procedural complications included transient ischemic attack and minor strokes.
- Long-term follow-up revealed a primary patency rate of 64.4% at 5 years, with in-stent restenosis occurring in 19.4% of patients.
Conclusions:
- Stenting for proximal atherosclerotic extracranial vertebral artery stenosis is a safe and feasible procedure.
- The study demonstrates a good middle to long-term patency rate.
- Further clinical trials are recommended to validate these outcomes.
Abstract:
Objective: To evaluate the effect of stenting for proximal atherosclerotic extracranial vertebral artery stenosis. Methods: A total of 204 proximal atherosclerotic extracranial vertebral artery stenosis patients underwent stent implantation at Fuwai Hospital were enrolled consecutively between August 2007 and June 2014 prospectively. Medical records were collected and the clinical results were obtained through outpatient and telephone follow up. Results: (1) The patients were (64.1±7.9) years old, and 179 were male (87.7%). (2) Stent implantation was performed on 210 proximal atherosclerotic extracranial vertebral artery stenosis lesions with 210 stents (156 on the left, 54 on the right), and 6 patients received both sides stent implantations. Technical success rate was 100%(210/210). The stenosis of the lesions was decreased from (85.1±6.4) % to (6.5±3.2) % after the stent implantation (P<0.01). (3) Three (1.5%) patients experienced transient ischemic attack during the procedure, and two (1.0%) patients suffered from minor posterior circulation ischemic strokes on the 2nd and 10th day after the procedure, respectively. (4)The median follow-up was 1.5 (0.8-2.5) years. Three(1.5%) patients died (two non-vacular deaths, and the other one due to sudden cardiac death). Three (1.5%) patients developed stroke (one case ipsilateral posterior circulation stroke, and two cases unrelated area stroke). Four (2.0%) patients experienced transient ischemic attack. One patient suffered nonfatal myocardial infraction. In-stent restenosis occurred in thirty nine (19.4%) patients, of which fourteen (35.9%) patients were totally occluded and four (10.3%) patients with symptomatic restenosis. Kaplan-Meier survival curve showed that the primary patency rate of the vertebral artery were 85.6%, 78.6%, 72.2% and 64.4% at 1, 2, 3 and 5 years, respectively. Conclusions: Stenting for proximal atherosclerotic extracranial vertebral artery stenosis is safe and feasible, with a good middle to long-term patency rate. However, further trials are required to validate the effective results found in this patients cohort.
