Percutaneous Interventional Treatment of Extracranial Vertebral Artery Stenosis with Coronary Stents

Ko, Young Guk; Park, Sungha; Kim, Jong Youn; Min, Pil Ki; Choi, Eui Young; Jung, Jae Hun; Joung, Boyoung; Choi, Donghoon; Jang, Yangsoo; Shim, Won Heum

Abstract

Stenosis of extracranial vertebral artery (VA) is not an infrequent lesion, and it can pose a significant clinical problem. However, the standard treatment for a significant VA stenosis has still not been established. Here in this study, we report our experiences of VA stenting in 25 patients (age 56.2 +/-15.2 years, male 76%). The patients had comorbidities as follows: DM (36%), hypertension (64%), Takayasu's (12%) and Behcet's diseases (4%). There were combined involvement of other vessels such as the coronary artery (72%), carotid artery (36%), subclavian artery (32%) and the contralateral vertebral artery (24%). Indications for stenting were prior stroke or symptoms related to vertebrobasilar ischemia in 11 patients, and an asymptomatic but angiographically significant stenosis (> 70% stenosis) in 14 patients. Twenty-three balloon-expandable stents and two self-expandable stents were deployed. A drug-eluting coronary stent and distal balloon protection device were each used in one case. A technically successful procedure was achieved in all patients. The baseline reference diameter was 4.7 +/-1.3 mm, minimal luminal diameter (MLD) 1.0 +/-0.6 mm (diameter stenosis 77.8 +/-12.5%) and lesion length 6.4 +/-3.9 mm. After stenting and adjuvant dilation, the MLD was increased to 4.5 +/-0.9 mm (diameter stenosis 3.1 +/-17.9%). There were no procedure-related complications. During the further follow-up period of 25 (3-49) months, no stroke or death occurred. Restenosis was observed in 4 (30.8%) of 13 eligible patients. In conclusion, VA stenting is feasible with a high degree of technical success, and this treatment is associated with a relatively low incidence of procedure-related complications. However, a relative high rate of in-stent restenosis remains as a problem to be resolved.