Skip to main content
SpringerLink
Log in

Vertebral artery ostial stent placement for atherosclerotic stenosis in 72 consecutive patients: clinical outcomes and follow-up results

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

The study’s purpose is to report the technical and clinical outcomes of a patient cohort that underwent vertebral artery ostium stent placement for atherosclerotic stenosis.

Methods

We retrospectively analyzed a prospectively collected database of neurointerventional procedures performed at a single center from 1999 to 2005. Outcome measures included recurrent transient neurological deficits (TNDs), stroke, and death. Kaplan–Meier analysis was used to estimate stroke- and/or death-free survival at 12 months. Cox proportional hazard was used to identify risk factors for recurrent vertebrobasilar ischemic events.

Results

Seventy-two patients with 77 treated vertebral ostial lesions were included. The 30-day stroke and/or death rate was 5.2% (n = 4), although no event was directly related to the vertebral ostium stent placement. Three procedure-related strokes were secondary to attempted stent placement at other sites (one carotid artery and two basilar arteries), and the one death was secondary to the presenting stroke severity. The mean clinical follow-up time available for 66 patients was 9 months. There were 14 TNDs (21%), two strokes (3%), and two deaths (3%) recorded in the follow-up. Recurrent vertebrobasilar ischemic events occurred in nine patients (seven TNDs and two strokes). No recurrent stroke and/or deaths were related to the treated vertebral ostium. Stroke- and/or death-free survival rate (including periprocedural stroke and/or death) was 89 ± 5% at 12 months. No vascular risk factor was significantly associated with recurrent vertebrobasilar ischemic events.

Conclusions

Vertebral artery ostium stent placement can be safely and effectively performed with a low rate of recurrent stroke in the territory of the treated vessel. Patients who also underwent attempted treatment of a tandem intracranial stenosis appeared to be at highest risk for periprocedure stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. SSYLVIA Study Investigators (2004) Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results. Stroke 35:1388–1392. doi:10.1161/01.STR.0000128708.86762.d6

    Article  Google Scholar 

  2. Akins PT, Kerber CW, Pakbaz RS (2008) Stenting of vertebral artery origin atherosclerosis in high-risk patients: bare or coated? A single-center consecutive case series. J Invasive Cardiol 20:14–20

    PubMed  Google Scholar 

  3. Biller J, Bruno A, Adams HP Jr, Godersky JC, Loftus CM, Mitchell VL, Banwart KJ, Jones MP (1989) A randomized trial of aspirin or heparin in hospitalized patients with recent transient ischemic attacks. A pilot study. Stroke 20:441–447

    PubMed  CAS  Google Scholar 

  4. Boulos AS, Agner C, Deshaies EM (2005) Preliminary evidence supporting the safety of drug-eluting stents in neurovascular disease. Neurol Res 27(Suppl 1):S95–S102. doi:10.1179/016164105X35459

    Article  PubMed  Google Scholar 

  5. Caplan L (1996) Posterior circulation disease: clinical findings, diagnosis and management. Blackwell Science, Boston, MA, pp 198–230

    Google Scholar 

  6. Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, Teal P, Dashe JF, Chaves CJ, Breen JC, Vemmos K, Amarenco P, Tettenborn B, Leary M, Estol C, Dewitt LD, Pessin MS (2004) New England Medical Center Posterior Circulation registry. Ann Neurol 56:389–398. doi:10.1002/ana.20204

    Article  PubMed  Google Scholar 

  7. Chastain HD 2nd, Campbell MS, Iyer S, Roubin GS, Vitek J, Mathur A, Al-Mubarak NA, Terry JB, Yates V, Kretzer K, Alred D, Gomez CR (1999) Extracranial vertebral artery stent placement: in-hospital and follow-up results. J Neurosurg 91:547–552

    Article  PubMed  Google Scholar 

  8. Chiras J, Vallee JN, Spelle L, Piotin M, Crozier S, Manai R, Rose M, Samson Y, Rancurel G (2002) Endoluminal dilatations and stenosis of symptomatic vertebral arteries. Rev Neurol (Paris) 158:51–57

    CAS  Google Scholar 

  9. Cloud GC, Crawley F, Clifton A, McCabe DJ, Brown MM, Markus HS (2003) Vertebral artery origin angioplasty and primary stenting: safety and restenosis rates in a prospective series. J Neurol Neurosurg Psychiatry 74:586–590. doi:10.1136/jnnp.74.5.586

    Article  PubMed  CAS  Google Scholar 

  10. Cloud GC, Markus HS (2004) Vertebral artery stenosis. Curr Treat Options Cardiovasc Med 6:121–127. doi:10.1007/s11936-004-0040-5

    Article  PubMed  Google Scholar 

  11. Coward LJ, Featherstone RL, Brown MM (2005) Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis. Cochrane Database Syst Rev (2):CD000516

  12. Eberhardt O, Naegele T, Raygrotzki S, Weller M, Ernemann U (2006) Stenting of vertebrobasilar arteries in symptomatic atherosclerotic disease and acute occlusion: case series and review of the literature. J Vasc Surg 43:1145–1154. doi:10.1016/j.jvs.2006.02.027

    Article  PubMed  Google Scholar 

  13. Flossmann E, Rothwell PM (2003) Prognosis of vertebrobasilar transient ischaemic attack and minor stroke. Brain 126:1940–1954. doi:10.1093/brain/awg197

    Article  PubMed  Google Scholar 

  14. Grotta JC, Norris JW, Kamm B (1992) Prevention of stroke with ticlopidine: who benefits most? TASS Baseline and Angiographic Data Subgroup. Neurology 42:111–115

    PubMed  CAS  Google Scholar 

  15. Hass WK, Fields WS, North RR, Kircheff II, Chase NE, Bauer RB (1968) Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. JAMA 203:961–968. doi:10.1001/jama.203.11.961

    Article  PubMed  CAS  Google Scholar 

  16. Hatano T, Tsukahara T, Ogino E, Aoyama T, Nakakuki T, Murakami M (2005) Stenting for vertebrobasilar artery stenosis. Acta Neurochir Suppl (Wien) 94:137–141. doi:10.1007/3-211-27911-3_22

    Article  CAS  Google Scholar 

  17. Higashida RT, Tsai FY, Halbach VV, Dowd CF, Smith T, Fraser K, Hieshima GB (1993) Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries. J Neurosurg 78:192–198

    Article  PubMed  CAS  Google Scholar 

  18. Hutchinson EC, Yates PO (1956) The cervical portion of the vertebral artery; a clinico-pathological study. Brain 79:319–331. doi:10.1093/brain/79.2.319

    Article  PubMed  CAS  Google Scholar 

  19. Jenkins JS, White CJ, Ramee SR, Collins TJ, Chilakamarri VK, McKinley KL, Jain SP (2001) Vertebral artery stenting. Catheter Cardiovasc Interv 54:1–5. doi:10.1002/ccd.1228

    Article  PubMed  CAS  Google Scholar 

  20. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  21. Ko YG, Park S, Kim JY, Min PK, Choi EY, Jung JH, Joung B, Choi D, Jang Y, Shim WH (2004) Percutaneous interventional treatment of extracranial vertebral artery stenosis with coronary stents. Yonsei Med J 45:629–634

    PubMed  Google Scholar 

  22. Lin YH, Juang JM, Jeng JS, Yip PK, Kao HL (2004) Symptomatic ostial vertebral artery stenosis treated with tubular coronary stents: clinical results and restenosis analysis. J Endovasc Ther 11:719–726. doi:10.1583/04-1336.1

    Article  PubMed  Google Scholar 

  23. Malek AM, Higashida RT, Phatouros CC, Lempert TE, Meyers PM, Gress DR, Dowd CF, Halbach VV (1999) Treatment of posterior circulation ischemia with extracranial percutaneous balloon angioplasty and stent placement. Stroke 30:2073–2085

    PubMed  CAS  Google Scholar 

  24. Moufarrij NA, Little JR, Furlan AJ, Williams G, Marzewski DJ (1984) Vertebral artery stenosis: long-term follow-up. Stroke 15:260–263

    PubMed  CAS  Google Scholar 

  25. Mukherjee D, Roffi M, Kapadia SR, Bhatt DL, Bajzer C, Ziada KM, Kalahasti V, Hughes K, Yadav JS (2001) Percutaneous intervention for symptomatic vertebral artery stenosis using coronary stents. J Invasive Cardiol 13:363–366

    PubMed  CAS  Google Scholar 

  26. Olsson JE, Brechter C, Backlund H, Krook H, Muller R, Nitelius E, Olsson O, Tornberg A (1980) Anticoagulant vs anti-platelet therapy as prophylactic against cerebral infarction in transient ischemic attacks. Stroke 11:4–9

    PubMed  CAS  Google Scholar 

  27. Qureshi AI, Ziai WC, Yahia AM, Mohammad Y, Sen S, Agarwal P, Zaidat OO, Suarez JI, Wityk RJ (2003) Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: a multicenter study. Neurosurgery 52:1033–1039. doi:10.1227/01.NEU.0000057744.96295.9F discussion 1039–1040

    Article  PubMed  Google Scholar 

  28. Qureshi AI, Kirmani JF, Harris-Lane P, Divani AA, Ahmed S, Ebrihimi A, Al Kawi A, Janjua N (2006) Vertebral artery origin stent placement with distal protection: technical and clinical results. AJNR Am J Neuroradiol 27:1140–1145

    PubMed  CAS  Google Scholar 

  29. Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T (2006) Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke 37:577–617. doi:10.1161/01.STR.0000199147.30016.74

    Article  PubMed  Google Scholar 

  30. Sivenius J, Riekkinen PJ, Smets P, Laakso M, Lowenthal A (1991) The European Stroke Prevention Study (ESPS): results by arterial distribution. Ann Neurol 29:596–600. doi:10.1002/ana.410290605

    Article  PubMed  CAS  Google Scholar 

  31. Storey GS, Marks MP, Dake M, Norbash AM, Steinberg GK (1996) Vertebral artery stenting following percutaneous transluminal angioplasty. Technical note. J Neurosurg 84:883–887

    Article  PubMed  CAS  Google Scholar 

  32. Taylor RA, Siddiq F, Suri MF, Martin CO, Hayakawa M, Chaloupka JC (2008) Risk factors for in-stent restenosis after vertebral ostium stenting. J Endovasc Ther 15:203–212. doi:10.1583/07-2175.1

    Article  PubMed  Google Scholar 

  33. Weber W, Mayer TE, Henkes H, Kis B, Hamann GF, Holtmannspoetter M, Brueckmann H, Kuehne D (2005) Efficacy of stent angioplasty for symptomatic stenoses of the proximal vertebral artery. Eur J Radiol 56:240–247. doi:10.1016/j.ejrad.2005.05.009

    Article  PubMed  CAS  Google Scholar 

  34. Wehman JC, Hanel RA, Guidot CA, Guterman LR, Hopkins LN (2004) Atherosclerotic occlusive extracranial vertebral artery disease: indications for intervention, endovascular techniques, short-term and long-term results. J Interv Cardiol 17:219–232. doi:10.1111/j.1540-8183.2004.04055.x

    Article  PubMed  Google Scholar 

  35. Wityk RJ, Chang HM, Rosengart A, Han WC, DeWitt LD, Pessin MS, Caplan LR (1998) Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 55:470–478. doi:10.1001/archneur.55.4.470

    Article  PubMed  CAS  Google Scholar 

  36. Zavala-Alarcon E, Emmans L, Cecena F, Little R, Bant A (2007) Percutaneous vertebral artery intervention: a necessary tool in every interventional cardiologist armamentarium. Cardiovasc Revasc Med 8:107–113. doi:10.1016/j.carrev.2006.11.004

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Kiwon Lee, MD and Shahram Malik, MD for their suggestions on manuscript preparation.

Conflict of interest statement

We declare that we have no conflicts of interest.

Author information

Authors and Affiliations

  1. Zeenat Qureshi Stroke Research Center, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA

    Robert A. Taylor, Muhammad Zeeshan Memon, Adnan I. Qureshi & Gabriela Vazquez

  2. Department of Neurosurgery, University of Minnesota, D-429, 420 Delaware Street SE, Minneapolis, MN, 55455, USA

    Farhan Siddiq

  3. Section of Interventional Neuroradiology, Department of Radiology, College of Medicine, University of Iowa, 200 Hawkins Drive 3950 JPP, Iowa City, IA, 52242, USA

    Minako Hayakawa & John C. Chaloupka

Authors
  1. Robert A. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Farhan Siddiq
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muhammad Zeeshan Memon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adnan I. Qureshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gabriela Vazquez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Minako Hayakawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John C. Chaloupka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert A. Taylor.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taylor, R.A., Siddiq, F., Memon, M.Z. et al. Vertebral artery ostial stent placement for atherosclerotic stenosis in 72 consecutive patients: clinical outcomes and follow-up results. Neuroradiology 51, 531–539 (2009). https://doi.org/10.1007/s00234-009-0531-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-009-0531-x

Keywords

Search

Navigation