Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Chung, Sun-Young (Department of Radiology, Research Instiute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Deok-Hee (Department of Radiology, Research Instiute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Jin-Woo (Department of Radiology, Research Instiute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Byung-Se (Department of Radiology, Research Instiute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • In, Hyun-Sin (Department of Radiology, Research Instiute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sun-Mi (Department of Radiology, Research Instiute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Choong-Gon (Department of Radiology, Research Instiute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sang-Joon (Department of Radiology, Research Instiute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Suh, Dae-Chul (Department of Radiology, Research Instiute of Radiology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2009.09.08
  • Accepted : 2009.11.27
  • Published : 2010.04.01
⟨ Previous Next ⟩

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.

Keywords

References

  1. Fisher CM. Occlusion of the vertebral arteries. Causing transient basilar symptoms. Arch Neurol 1970;22:13-19 https://doi.org/10.1001/archneur.1970.00480190017003
  2. Wityk RJ, Chang HM, Rosengart A, Han WC, DeWitt LD, Pessin MS, et al. Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 1998;55:470-478 https://doi.org/10.1001/archneur.55.4.470
  3. Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, et al. New England Medical Center Posterior Circulation Registry. Ann Neurol 2004;56:389-398 https://doi.org/10.1002/ana.20204
  4. Koroshetz WJ, Ropper AH. Artery-to-artery embolism causing stroke in the posterior circulation. Neurology 1987;37:292-295 https://doi.org/10.1212/WNL.37.2.292
  5. Caplan LR, Amarenco P, Rosengart A, Lafranchise EF, Teal PA, Belkin M, et al. Embolism from vertebral artery origin occlusive disease. Neurology 1992;42:1505-1512 https://doi.org/10.1212/WNL.42.8.1505
  6. Piotin M, Spelle L, Martin JB, Weill A, Rancurel G, Ross IB, et al. Percutaneous transluminal angioplasty and stenting of the proximal vertebral artery for symptomatic stenosis. AJNR Am J Neuroradiol 2000;21:727-731
  7. Albuquerque FC, Fiorella D, Han P, Spetzler RF, McDougall CG. A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery 2003;53:607-614 https://doi.org/10.1227/01.NEU.0000079494.87390.28
  8. Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results. Stroke 2004;35:1388-1392 https://doi.org/10.1161/01.STR.0000128708.86762.d6
  9. Ko YG, Park S, Kim JY, Min PK, Choi EY, Jung JH, et al. Percutaneous interventional treatment of extracranial vertebral artery stenosis with coronary stents. Yonsei Med J 2004;45:629-634 https://doi.org/10.3349/ymj.2004.45.4.629
  10. Lin YH, Juang JM, Jeng JS, Yip PK, Kao HL. Symptomatic ostial vertebral artery stenosis treated with tubular coronary stents: clinical results and restenosis analysis. J Endovasc Ther 2004;11:719-726 https://doi.org/10.1583/04-1336.1
  11. Wehman JC, Hanel RA, Guidot CA, Guterman LR, Hopkins LN. Atherosclerotic occlusive extracranial vertebral artery disease: indications for intervention, endovascular techniques, short-term and long-term results. J Interv Cardiol 2004;17:219-232 https://doi.org/10.1111/j.1540-8183.2004.04055.x
  12. Weber W, Mayer TE, Henkes H, Kis B, Hamann GF, Holtmannspoetter M, et al. Efficacy of stent angioplasty for symptomatic stenoses of the proximal vertebral artery. Eur J Radiol 2005;56:240-247 https://doi.org/10.1016/j.ejrad.2005.05.009
  13. Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown MM. Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Stroke 2007;38:1526-1530 https://doi.org/10.1161/STROKEAHA.106.471862
  14. Gupta R, Al-Ali F, Thomas AJ, Horowitz MB, Barrow T, Vora NA, et al. Safety, feasibility, and short-term follow-up of drug-eluting stent placement in the intracranial and extracranial circulation. Stroke 2006;37:2562-2566 https://doi.org/10.1161/01.STR.0000242481.38262.7b
  15. Qureshi AI, Kirmani JF, Harris-Lane P, Divani AA, Ahmed S, Ebrihimi A, et al. Vertebral artery origin stent placement with distal protection: technical and clinical results. AJNR Am J Neuroradiol 2006;27:1140-1145
  16. Kim SR, Baik MW, Yoo SH, Park IS, Kim SD, Kim MC. Stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery origin and treatment with the stent-instent technique. Report of two cases. J Neurosurg 2007;106:907-911 https://doi.org/10.3171/jns.2007.106.5.907
  17. Tsutsumi M, Kazekawa K, Onizuka M, Kodama T, Matsubara S, Aikawa H, et al. Stent fracture in revascularization for symptomatic ostial vertebral artery stenosis. Neuroradiology 2007;49:253-257 https://doi.org/10.1007/s00234-006-0185-x
  18. Chastain HD 2nd, Campbell MS, Iyer S, Roubin GS, Vitek J, Mathur A, et al. Extracranial vertebral artery stent placement: in-hospital and follow-up results. J Neurosurg 1999;91:547-552 https://doi.org/10.3171/jns.1999.91.4.0547
  19. Taylor RA, Siddiq F, Suri MF, Martin CO, Hayakawa M, Chaloupka JC. Risk factors for in-stent restenosis after vertebral ostium stenting. J Endovasc Ther 2008;15:203-212 https://doi.org/10.1583/07-2175.1
  20. Horlitz M, Amin FR, Boerrigter G, Sigwart U, Clague JR. Restenosis after successful ostial stent implantation: the role of statins compared with conventional treatment. J Interv Cardiol 2004;17:301-306 https://doi.org/10.1111/j.1540-8183.2004.00326.x
  21. Park DW, Hong MK, Suh IW, Hwang ES, Lee SW, Jeong YH, et al. Results and predictors of angiographic restenosis and long-term adverse cardiac events after drug-eluting stent implantation for aorto-ostial coronary artery disease. Am J Cardiol 2007;99:760-765 https://doi.org/10.1016/j.amjcard.2006.10.028
  22. Phipp LH, Scott DJ, Kessel D, Robertson I. Subclavian stents and stent-grafts: cause for concern? J Endovasc Surg 1999;6:223-226 https://doi.org/10.1583/1074-6218(1999)006<0223:SSASCF>2.0.CO;2
  23. Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA 1999;282:2035-2042 https://doi.org/10.1001/jama.282.21.2035
  24. Lederman RJ, Mendelsohn FO, Santos R, Phillips HR, Stack RS, Crowley JJ. Primary renal artery stenting: characteristics and outcomes after 363 procedures. Am Heart J 2001;142:314-323 https://doi.org/10.1067/mhj.2001.116958
  25. Lin YH, Hung CS, Tseng WY, Lee RK, Wang YC, Lin MS, et al. Safety and feasibility of drug-eluting stent implantation at vertebral artery origin: the first case series in Asians. J Formos Med Assoc 2008;107:253-258 https://doi.org/10.1016/S0929-6646(08)60144-8
  26. Drescher R, Mathias KD, Jaeger HJ, Bockisch G, Demirel E, Gissler HM, et al. Clinical results of carotid artery stenting with a nitinol self-expanding stent (SMART stent). Eur Radiol 2002;12:2451-2456 https://doi.org/10.1007/s00330-001-1298-6
  27. Linfante I, Hirsch JA, Selim M, Schlaug G, Caplan LR, Reddy AS. Safety of latest-generation self-expanding stents in patients with NASCET-ineligible severe symptomatic extracranial internal carotid artery stenosis. Arch Neurol 2004;61:39-43 https://doi.org/10.1001/archneur.61.1.39
  28. Wakhloo AK, Tio FO, Lieber BB, Schellhammer F, Graf M, Hopkins LN. Self-expanding nitinol stents in canine vertebral arteries: hemodynamics and tissue response. AJNR Am J Neuroradiol 1995;16:1043-1051
  29. Vos AW, Linsen MA, Diks J, Rauwerda JA, Wisselink W. Carotid stent mobility with regard to head movements: in vitro analysis. Vascular 2004;12:369-373 https://doi.org/10.2310/6670.2004.00047
  30. Kern MJ, Ouellette D, Frianeza T. A new technique to anchor stents for exact placement in ostial stenoses: the stent tail wire or Szabo technique. Catheter Cardiovasc Interv 2006;68:901-906 https://doi.org/10.1002/ccd.20613
  31. Cheema A, Hong T. Buddy wire technique for stent placement at non-aorto ostial coronary lesions. Int J Cardiol 2007;118:e75-e80 https://doi.org/10.1016/j.ijcard.2007.01.023
  32. Divani AA, Berezina TL, Zhou J, Pakdaman R, Suri MF, Qureshi AI. Microscopic and macroscopic evaluation of emboli captured during angioplasty and stent procedures in extracranial vertebral and internal carotid arteries. J Endovasc Ther 2008;15:263-269 https://doi.org/10.1583/07-2326.1
  33. Kantarci F, Mihmanli I, Albayram MS, Barutca H, Gulsen F, Kocer N, et al. Follow-up of extracranial vertebral artery stents with Doppler sonography. AJR Am J Roentgenol 2006;187:779-787 https://doi.org/10.2214/AJR.05.0452
  34. Yoo WJ, Lim YS, Ahn KJ, Choi BG, Kim JY, Kim SH. Assessment of vertebral artery stents using 16-slice multi-detector row CT angiography in vivo evaluation: comparison of a medium-smooth kernel and a sharp kernel. Eur J Radiol 2009;70:362-368 https://doi.org/10.1016/j.ejrad.2008.01.039
  35. de Bray JM, Pasco A, Tranquart F, Papon X, Alecu C, Giraudeau B, et al. Accuracy of color-Doppler in the quantification of proximal vertebral artery stenoses. Cerebrovasc Dis 2001;11:335-340 https://doi.org/10.1159/000047663
  36. Suh DC, Kim SJ, Lee DH, Kim W, Choi CG, Lee JH, et al. Outcome of endovascular treatment in symptomatic intracranial vascular stenosis. Korean J Radiol 2005;6:1-7 https://doi.org/10.3348/kjr.2005.6.1.1

Cited by

  1. Stent Fracture and Occlusion after Treatment of Symptomatic Vertebral Artery Ostium Stenosis with a Self-Expanding Device : A Case Report vol.20, pp.6, 2010, https://doi.org/10.15274/inr-2014-10068
  2. Recanalization of Symptomatic Vertebral Ostial Occlusion in Patients with Acute or Subacute Stroke vol.35, pp.2, 2010, https://doi.org/10.3174/ajnr.a3681
  3. Commentary: Vertebral Artery Ostial Stenosis Stenting Technique : The Concept Reversed? vol.22, pp.3, 2015, https://doi.org/10.1177/1526602815583490
  4. Endovascular Recanalization of Nonacute Symptomatic Vertebral Ostial Occlusion Performed Using a Distal Embolic Protection Device vol.135, pp.None, 2010, https://doi.org/10.1016/j.wneu.2019.12.132