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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Endovascular Stenting for Vertebral Artery Stenosis

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana

Manuscript received April 17, 2009; revised manuscript received August 7, 2009, accepted August 10, 2009.

^_* Reprint requests and correspondence: Dr. J. Stephen Jenkins, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, Louisiana 70121 (Email: jsjenk{at}bellsouth.net).

Objectives: The aim of this study was to demonstrate the safety and long-term durability of catheter-based therapy for symptomatic vertebral artery stenosis (VAS).

Background: Symptomatic VAS carries with it a 5-year 30% to 35% risk of stroke. The 2-year mortality approaches 30% for medically managed strokes involving the posterior circulation. Surgical bypass is rarely performed, due to high morbidity and mortality. Endovascular revascularization with primary stenting offers an attractive treatment option for these patients.

Methods: One-hundred five consecutive symptomatic patients (112 arteries, 71% male) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995 to 2006. Fifty-seven patients (54%) had bilateral VAS, 71 patients (68%) had concomitant carotid disease, and 43 patients (41%) had a prior stroke.

Results: Procedural and clinical success was achieved in 105 (100%) and 95 (90.5%) patients, respectively. One-year follow-up was obtained in 87 (82.9%) patients, of which 69 patients (79.3%) remained symptom-free. At 1 year, 6 patients (5.7%) had died and 5 patients (5%) had a posterior circulation stroke. Target vessel revascularization occurred in 7.4% at 1 year. At a median follow-up of 29.1 months (interquartile range 12.8 to 50.9 months), 13.1% underwent target vessel revascularization, 71.4% were alive, and 70.5% remained symptom-free.

Conclusions: In experienced hands, stenting for symptomatic VAS can be accomplished with a very high success rate (100%), with few periprocedural complications, and is associated with durable symptom resolution in the majority (approximately 80%) of patients. We conclude that endovascular stenting of vertebral artery atherosclerotic disease is safe and effective compared with surgical controls and should be considered first-line therapy for this disease.

Key Words: vertebral artery angioplasty • percutaneous transluminal angioplasty • vertebral artery stenosis • vertebrobasilar insufficiency

Abbreviations and Acronyms   PAD = peripheral arterial disease   TIA = transient ischemic attack   VAS = vertebral artery stenosis   VBI = vertebrobasilar insufficiency   VBS = vertebrobasilar system

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