TY - JOUR
T1 - Second generation drug-eluting stents for endovascular treatment of ostial vertebral artery stenosis
T2 - A single center experience
AU - Ortega-Gutierrez, Santiago
AU - Lopez, Gloria V.
AU - Edgell, Randall C.
AU - Mendez, Aldo A.
AU - Dandapat, Sudeepta
AU - Roa, Jorge A.
AU - Zevallos, Cynthia B.
AU - Holcombe, Andrea L.
AU - Hasan, David
AU - Derdeyn, Colin P.
AU - Rossen, James
AU - Samaniego, Edgar A.
N1 - Publisher Copyright:
Copyright © 2019 Ortega-Gutierrez, Lopez, Edgell, Mendez, Dandapat, Roa, Zevallos, Holcombe, Hasan, Derdeyn, Rossen and Samaniego. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
PY - 2019
Y1 - 2019
N2 - Objective: To report a single-center experience using drug-eluting balloon mounted stents (DES) for endovascular treatment of atherosclerotic ostial vertebral artery stenosis (OVAS). Background: Posterior circulation is affected in up to 25% of strokes, 20% of them resulting from atherosclerotic OVAS. The optimal management of symptomatic OVAS remains controversial. DES have been introduced to improve restenosis rates. Methods: We retrospectively analyzed prospectively collected data from patients with dominant OVAS who underwent endovascular treatment with second-generation DES placement. Patient demographics, clinical presentation, comorbidities, stenosis severity, stent features, technical success, complications, and imaging follow-up were assessed. Results: Thirty patients were treated, predominantly male (86.6%). Sixteen patients presented with an acute stroke or TIA and fourteen were treated on an elective basis due to symptomatic chronic stenosis and contralateral occlusion. Comorbidities included hyperlipidemia (83%), hypertension (70%) and prior stroke (63.3%). Mean ostial stenosis at presentation was 80 ± 14.8%. Twenty-one patients had contralateral VA involvement. DES deployment was technically successful in all patients using everolimus eluting stents in 30 lesions and zotarolimus eluting stents in two. One technical complication (stent migration) and three (10%) minor peri-procedural complications occurred. Complications included one asymptomatic ischemic infarct in the posterior circulation, one femoral artery thrombosis and one post-procedure altered mental status secondary to contrast induced neurotoxicity. Mean imaging follow-up was 8.8 months. Two (7.6%) patients had in-stent restenosis and underwent retreatment with angioplasty. There were no procedure-related mortalities. Conclusion: Our study confirms the feasibility of deploying DES for the treatment of ostial vertebral artery stenosis with low periprocedural risk and low medium-term rates of re-stenosis.
AB - Objective: To report a single-center experience using drug-eluting balloon mounted stents (DES) for endovascular treatment of atherosclerotic ostial vertebral artery stenosis (OVAS). Background: Posterior circulation is affected in up to 25% of strokes, 20% of them resulting from atherosclerotic OVAS. The optimal management of symptomatic OVAS remains controversial. DES have been introduced to improve restenosis rates. Methods: We retrospectively analyzed prospectively collected data from patients with dominant OVAS who underwent endovascular treatment with second-generation DES placement. Patient demographics, clinical presentation, comorbidities, stenosis severity, stent features, technical success, complications, and imaging follow-up were assessed. Results: Thirty patients were treated, predominantly male (86.6%). Sixteen patients presented with an acute stroke or TIA and fourteen were treated on an elective basis due to symptomatic chronic stenosis and contralateral occlusion. Comorbidities included hyperlipidemia (83%), hypertension (70%) and prior stroke (63.3%). Mean ostial stenosis at presentation was 80 ± 14.8%. Twenty-one patients had contralateral VA involvement. DES deployment was technically successful in all patients using everolimus eluting stents in 30 lesions and zotarolimus eluting stents in two. One technical complication (stent migration) and three (10%) minor peri-procedural complications occurred. Complications included one asymptomatic ischemic infarct in the posterior circulation, one femoral artery thrombosis and one post-procedure altered mental status secondary to contrast induced neurotoxicity. Mean imaging follow-up was 8.8 months. Two (7.6%) patients had in-stent restenosis and underwent retreatment with angioplasty. There were no procedure-related mortalities. Conclusion: Our study confirms the feasibility of deploying DES for the treatment of ostial vertebral artery stenosis with low periprocedural risk and low medium-term rates of re-stenosis.
KW - Drug eluting stent
KW - Extracranial atherosclerotic disease
KW - Restenosis
KW - Stenting
KW - Vertebral artery stenosis
UR - https://www.scopus.com/pages/publications/85069782012
U2 - 10.3389/fneur.2019.00746
DO - 10.3389/fneur.2019.00746
M3 - Article
AN - SCOPUS:85069782012
SN - 1664-2295
VL - 10
JO - Frontiers in Neurology
JF - Frontiers in Neurology
IS - JUL
M1 - 746
ER -