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A Comparison of Different Endovascular Treatment for Vertebral Artery Origin Stenosis

Zigao Wang1, Yifeng Ling1, Hongchen Zhao1

  • 1Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.

World Neurosurgery
|June 14, 2022
PubMed

Insights

Drug-eluting stents (DES) are more effective than bare metal stents (BMS) for reducing restenosis in vertebral artery origin stenosis (VAOS). Angioplasty with drug-coated balloons (DCB) showed slower stenosis progression despite initial residual stenosis.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Vertebral artery origin stenosis (VAOS) can cause significant neurological symptoms.
  • Medical management alone is often insufficient for symptomatic VAOS.
  • Endovascular options are crucial for managing refractory VAOS.

Purpose of the Study:

  • To compare the safety and efficacy of drug-eluting stent (DES) versus bare metal stent (BMS) and angioplasty with drug-coated balloon (DCB) for symptomatic VAOS.
  • To evaluate outcomes including technical success, complications, residual stenosis, and long-term event rates.
  • To identify the optimal endovascular strategy for patients unresponsive to medical therapy.

Main Methods:

  • Retrospective analysis of 46 patients with symptomatic VAOS treated between December 2018 and November 2021.
  • Comparison of three treatment groups: DES (n=29), BMS (n=12), and DCB angioplasty (n=5).
  • Assessment of technical success, perioperative complications, residual stenosis, stroke recurrence, stenosis progression, and restenosis rates.

Main Results:

  • Technical success rates were 100% for DES, 100% for BMS, and 60% for DCB (P=0.008).
  • Restenosis rates were significantly lower with DES (6.9%) compared to BMS (50.0%) (P=0.007).
  • DCB group showed the slowest progression of residual stenosis (-8.0%) despite higher initial residual stenosis (51.2%).

Conclusions:

  • Drug-eluting stents (DES) demonstrate superior efficacy in reducing restenosis rates compared to bare metal stents (BMS) in VAOS.
  • Angioplasty with drug-coated balloons (DCB) offers a viable alternative, characterized by slower stenosis progression.
  • Endovascular treatment strategies should be individualized based on patient factors and desired outcomes for symptomatic VAOS.
Abstract

Keywords:
Bare mental stentDrug-coated balloonDrug-eluting stentRestenosisVertebral artery origin stenosis

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