A Reappraisal of Angioplasty and Stenting for the Treatment of Vertebral Origin Stenosis

Department

neurosurgery

Document Type

Article

Abstract

OBJECTIVE: To assess the rate of restenosis after vertebral origin angioplasty and stenting (VOAS). METHODS: We reviewed the records of 33 patients (24 men, 9 women; age range, 49-81 yr; mean, 64.5 yr) who underwent VOAS during a period of 5 years and followed each for the development of adverse sequelae through a prospectively maintained database. A neuroradiologist not involved in the stenting procedures assessed original and follow-up angiograms for evidence of restenosis. Restenosis was quantified as insignificant (0-24%), mild (25-49%), moderate (50-74%), or severe (75-100%). RESULTS: Of the 33 patients, 30 presented with transient ischemic attacks or stroke. Most (31 of 33 patients) manifested other brachiocephalic stenoses, including 27 patients with occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Angiographic follow-up (mean, 16.2 mo) was obtained in 30 patients (2 patients died before follow-up, and 1 refused). Restenosis was mild in seven patients, moderate in eight, and severe in five. The combined rate of moderate-to-severe restenosis was 43.3%. No complications resulted in permanent morbidity. One patient died as a result of a stroke in a different vascular distribution 4 months after VOAS. Another patient died as a result of basilar thrombosis in which emergent stenting had been undertaken in an effort to perform thrombolysis. CONCLUSION: Despite a technical success rate of 97% and a low incidence of complications, VOAS is associated with a high rate of moderate-to-severe restenosis.

Publication Date

2003

Publication Title

Neurosurgery

ISSN

0148-396X

Volume

53

Issue

3

First Page

607

Last Page

616

Digital Object Identifier (DOI)

10.1227/01.NEU.0000079494.87390.28

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