Korean J Radiol.  2010 Apr;11(2):156-163. 10.3348/kjr.2010.11.2.156.

Use of Self-Expanding Stents for the Treatment of Vertebral Artery Ostial Stenosis: a Single Center Experience

• Chung SY
• Lee DH
• Choi JW
• Choi BS
• In HS
• Kim SM
• Choi CG
• Kim SJ
• Suh DC

• KMID: 1783191
• DOI: http://doi.org/10.3348/kjr.2010.11.2.156

Abstract

OBJECTIVE
To evaluate our early experience using self-expanding stents to treat atherosclerotic vertebral artery ostial stenosis (VAOS), with respect to technical feasibility and clinical and imaging follow-up results.
MATERIALS AND METHODS
A total of 20 lesions in 20 patients underwent stenting of the VAOS using a self-expanding stent (Precise RX; Cordis Neurovascular, Miami Lakes, FL). Two patients were asymptomatic. We analyzed the technical success rate, causes of technical failure, occurrence of any vascular or neurological event, and the occurrence of any neurological abnormality or in-stent restenosis (ISR) seen on follow-up. The imaging follow-up was performed with Doppler ultrasound (DUS) as a primary screening modality.
RESULTS
One instance of technical failure was caused by failure of the guidewire passage. The stent diameter was 5 mm, and post-stenting balloon dilatations were necessary in all cases. Stent misplacement requiring placement of an additional stent occurred in four cases. Following a 14.8 month average clinical follow-up time, two patients showed anterior circulation ischemia, which was not attributed to the VAOS we treated. Following a 13.7 month average DUS follow-up, five patients showed a mild degree of diffuse or focal intimal thickening in the stent lumen; however, none of the stenosis showed luminal loss of more than 50% and no stent fracture was noted.
CONCLUSION
The use of self-expanding stents for treating VAOS was technically feasible and helped to improve artery patency during our limited follow-up interval.

Keyword

Vertebral artery ostial stenosis; Angioplasty; Stent; Self-expanding stent

MeSH Terms

Aged
Blood Vessel Prosthesis Implantation/methods
Feasibility Studies
Follow-Up Studies
Humans
Male
Middle Aged
*Stents
Treatment Outcome
Ultrasonography, Doppler/methods
Vascular Patency
Vertebral Artery/surgery/*ultrasonography
Vertebrobasilar Insufficiency/*therapy

Figure

• 

  Fig. 1 Placement of self-expanding stent in 68-year-old man who presented two weeks before procedure with right side weakness and ataxia due to multifocal embolic lesions in posterior circulation. A. Contrast-enhanced MR angiography shows bilateral ostial stenoses. Left vertebral artery ostial stenosis lesion was considered to be cause. B. Digital subtraction angiography shows focal severe stenosis of ostium. C. Lesion is pre-dilated with 4-mm angioplasty balloon. D. Self-expanding stent (Cordis Precise RX, 5 mm × 20 mm) is placed over stenotic lesion, which leaves residual stenosis (arrow). E. Residual stenosis is successfully dilated using 5-mm balloon angioplasty catheter. F. Final control angiogram shows minimal residual stenosis without flow restriction. G. Chest radiograph obtained 12 months after procedure shows full expansion of whole stent. H. Clinical and Doppler ultrasound follow-up performed 21 months after procedure shows good patency of stent without significant intimal hyperplasia.

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