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He F, Zhong C, Wu C, Liu Y, Yu S. Relationship between serum endothelin-1 and in-stent restenosis following vertebral artery stenting. Neurol Sci 2024; 45:2711-2717. [PMID: 38157103 PMCID: PMC11081976 DOI: 10.1007/s10072-023-07276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
The study objective was to investigate the relations between serum endothelin-1 and in-stent restenosis in vertebral artery stenting. Sixty-eight patients undergoing re-examination of vertebral artery stenting in the Department of Cerebrovascular Disease, Hangzhou Third People's Hospital, between April 2019 and October 2022, were invited to participate. According to the presence of vertebral artery stenting, patients were divided into the restenosis (n = 19) or non-restenosis (n = 49) groups. General clinical data and endothelin-1 levels were compared between the groups. Logistic regression analysis was used to explore the relations between endothelin-1 level and risk for in-stent restenosis. Receiver operating characteristic curves were drawn to test the diagnostic value of serum endothelin-1 level for in-stent restenosis. Compared with the non-restenosis group, restenosis group levels of low-density lipoprotein, triglycerides, and endothelin-1 were significantly higher (p < 0.05) Multivariate logistic regression analysis showed that endothelin-1, stent length, and low-density lipoprotein were independently associated with in-stent restenosis (odds ratio = 1.502, 95% confidence interval: 0.042 ~ 0.212, p = 0.000; odds ratio = 1.899, 95% confidence interval: 1.116 ~ 2.237, p = 0.000; odds ratio = 1.899, 95% confidence interval: 1.228 ~ 3.337, p = 0.001, respectively). Area under the curve for serum endothelin-1 in the diagnosis of vertebral artery in-stent restenosis was 0.938. The best diagnostic cut-off value was 11.94 ng/L. Sensitivity was 89.5%. Specificity was 85.7%. These cumulative data indicate that endothelin-1 level is independently associated with in-stent restenosis.
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Affiliation(s)
- Fang He
- Physical Examination Center, Hangzhou Third People's Hospital, Hangzhou, China
| | - Changyang Zhong
- Cerebrovascular Disease Department, Hangzhou Third People's Hospital, Hangzhou, China.
| | - Chunli Wu
- Cerebrovascular Disease Department, Hangzhou Third People's Hospital, Hangzhou, China
| | - Yuan Liu
- Cerebrovascular Disease Department, Hangzhou Third People's Hospital, Hangzhou, China
| | - Shufeng Yu
- Department of Radiology, Zhejiang People's Hospital, Hangzhou, China
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Guo J, Ning Y, Wu S, Zhang F, Li Y, Xu Z, Guo L, Gu Y. Risk factors for in-stent restenosis after vertebral artery stenting of V1 segment: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2022; 100:279-289. [PMID: 35730645 DOI: 10.1002/ccd.30296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/31/2022] [Accepted: 05/29/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In-stent restenosis (ISR) remains a challenge in the treatment of vertebral artery V1 segment stenosis. The aim of this meta-analysis is to identify the risk factors of ISR. METHODS Studies eligible for inclusion criteria were found in PubMed, Embase, and Cochrane Library databases. Data related to risk factors of ISR were extracted from the included studies, and pooled analysis was performed when data of the same factor were available in ≥2 studies. Dichotomous outcomes were analyzed with odds ratios (OR) and continuous outcomes were analyzed with a weighted mean difference (WMD). The Stata 14.0 program was used for the meta-analysis. RESULTS A total of 11 studies involving 1356 patients were included in our analysis. Pooled analyses showed that younger age (p = 0.01; WMD= -1.958; 95% confidence interval [CI], -3.453 to -0.463) and V1 tortuosity (p = 0.004; OR = 4.145; 95% CI, 1.56-11.012) significantly associated with higher risk of ISR in V1 segment stenting. While bare-metal stents, stent diameter and length, diabetes mellitus, coronary artery disease, and smoking were not found to increase ISR rates. CONCLUSIONS This meta-analysis showed that young age and V1 tortuosity increase the ISR rates after vertebral V1 segment stenting.
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Affiliation(s)
- Julong Guo
- Department of Vascular Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yachan Ning
- Department of Vascular Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Sensen Wu
- Department of Vascular Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Fan Zhang
- Department of Vascular Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yang Li
- Department of Vascular Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zeqin Xu
- Department of Vascular Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
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Qin Y, Shi Y, Zhuo H, Yu T, Wang W, Li X, Da L, Ran F. Short-term efficacy and safety of TurboHawk atherectomy for in-stent restenosis in peripheral artery disease: a single-centre experience. ANZ J Surg 2022; 92:448-452. [PMID: 35040546 DOI: 10.1111/ans.16551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 11/05/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Information regarding the efficacy of the TurboHawk atherectomy for the treatment of in-stent restenosis (ISR) in patients with peripheral artery disease (PAD) of the lower extremity is scarce. This study was performed to investigate the curative efficacy and safety of the TurboHawk system for ISR in PAD patients over 60 years old. METHODS The TurboHawk atherectomy device was used to treat ISR in 28 patients with PAD. The intraoperative, 2-day postoperative, 3-month, and 2-year follow-up data were obtained. Differences in the ankle-brachial index (ABI), Rutherford class and minimum diameter of the femoral-popliteal artery were analysed along with the correlations of the factors associated with patency. RESULTS Twenty-six patients (92.86%) had successful surgeries. All patients reported alleviation of pain and intermittent claudication after surgery. One patient who had a malignant hepatoma and coronary heart disease received an amputation on the 76th postoperative day and another patient who had atrial fibrillation received a thrombectomy on the 40th postoperative day. TurboHawk atherectomy increased the ABI (from 0.30 to 0.70, P < 0.0001) and minimum diameter (from 0 to 4.93 mm, P < 0.0001) and reduced the Rutherford class (from 4.00 to 2.00, P < 0.0001). During the 3-month follow-up, the median minimum diameter, ABI, and Rutherford class were 4.12, 0.69, and 2.00, respectively. No death happened during the 3-month follow-up. CONCLUSIONS The TurboHawk atherectomy is a safe and effective technique for ISR in PAD patients over 60 years old.
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Affiliation(s)
- Yi Qin
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yan Shi
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Huawei Zhuo
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Tong Yu
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Wei Wang
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiaoqiang Li
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Lun Da
- Nanjing Prevention and Treatment Center for Occupational Disease, Nanjing, Jiangsu, China
| | - Feng Ran
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
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The Relationship Between APOE Gene Polymorphism and In-stent Restenosis After Stenting at the Beginning of the Vertebral Artery. World Neurosurg 2021; 158:e277-e282. [PMID: 34728399 DOI: 10.1016/j.wneu.2021.10.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To retrospectively investigate the relationship between apolipoprotein E (APOE) gene polymorphism and in-stent restenosis (ISR) after stenting at the beginning of the vertebral artery. METHODS The study included 155 patients who successfully underwent stenting at the beginning of the vertebral artery and had postoperative digital subtraction angiography or computed tomography angiography. Based on the follow-up results, they were divided into the restenosis (ISR) group and non-restenosis (non-ISR) group. The clinical information and APOE genotypes of both groups were analyzed. A binary logistic regression model was used to analyze independent risk factors for ISR. RESULTS After 1 year of follow-up, 49 (31.6%) patients had ISR and 106 (68.4%) did not. Binary logistic regression analysis showed that serum low-density lipoprotein cholesterol (LDL-C), serum lipoprotein-related phospholipase A2 (Lp-PLA2), and E3/E4 genotype were independent risk factors for ISR after stenting at the beginning of the vertebral artery. In addition, the LDL-C level of patients with the E3/E4 genotype was higher compared with the E3/E3 genotype group (P < 0.05). CONCLUSIONS APOE gene polymorphism is associated with ISR, and the E3/E4 genotype is an independent risk factor for ISR after stenting at the beginning of the vertebral artery. Further genetic studies can identify risk genotypes to facilitate the early prediction and identification of high-risk patients with ISR.
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Long-term results of extensive aortoiliac occlusive disease (EAIOD) treated by endovascular therapy and risk factors for loss of primary patency. Chin Med J (Engl) 2020; 134:913-919. [PMID: 33323822 PMCID: PMC8078323 DOI: 10.1097/cm9.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Although endovascular therapy has been widely used for focal aortoiliac occlusive disease (AIOD), its performance for extensive AIOD (EAIOD) is not fully evaluated. We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency. Methods: Between January 2008 and June 2018, patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II (TASC II) C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled. Demographic, diagnosis, procedure characteristics, and follow-up information were reviewed. Univariate analysis was used to identify the correlation between the variables and the primary patency. A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency. Five- and 10-year primary and secondary patency, as well as survival rates, were calculated by Kaplan-Meier analysis. Results: A total of 148 patients underwent endovascular treatment in our center. Of these, 39.2% were classified as having TASC II C lesions and 60.8% as having TASC II D lesions. The technical success rate was 88.5%. The mean follow-up time was 79.2 ± 29.2 months. Primary and secondary patency was 82.1% and 89.4% at 5 years, and 74.8% and 83.1% at 10 years, respectively. The 5-year survival rate was 84.2%. Compared with patients without loss of primary patency, patients with this condition showed significant differences in age, TASC II classification, infrainguinal lesions, critical limb ischemia (CLI), and smoking. Multivariate logistic regression analysis showed age <61 years (adjusted odds ratio [aOR]: 6.47; 95% CI: 1.47–28.36; P = 0.01), CLI (aOR: 7.81; 95% CI: 1.92–31.89; P = 0.04), and smoking (aOR: 10.15; 95% CI: 2.79–36.90; P < 0.01) were independent risk factors for the loss of primary patency. Conclusion: Endovascular therapy was an effective treatment for EAIOD with encouraging patency and survival rate. Age <61 years, CLI, and smoking were independent risk factors for the loss of primary patency.
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Comparison of drug-eluting and bare metal stents for extracranial vertebral artery stenting. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:328-337. [PMID: 31592257 PMCID: PMC6777189 DOI: 10.5114/aic.2019.87887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/01/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Drug-eluting stents of the first (DES I) and second generation (DES II) proved superior to bare metal stents (BMS) in the coronary territory. However, there are limited data on whether they have any advantage over BMS in vertebral artery stenosis (VAS). Aim To compare outcomes of DES (DES I, DES II) and BMS in the treatment of symptomatic extracranial VAS. Material and methods During 13-year study period (2003–2016), 392 consecutive patients underwent VAS angioplasty in 428 arteries, including implantation of 148 DES (DES I: 21; DES II: 127 lesions), and 280 BMS. Results The technical success rates for DES and BMS groups were 96.7% and 94.6% (p = 0.103), with similar periprocedural complication rates (1.4% vs. 2.2%; p = 0.565). VAS degree was reduced from 86 ±9.7 to 2.7 ±5.0% in DES (p < 0.001) and from 84.1 ±9.4 to 4.3 ±6.9% in BMS (p < 0.001). Angiography confirmed in-stent restenosis/occlusion (ISR/ISO) 50–99% in 53 (14.2%) and 21 (5.6%) out of 373 patients (409 arteries) with at least 6-month follow-up. ISR/ISO rates were similar in DES vs. BMS (22.8% vs. 19.4%; p = 0.635), as well as in DES I vs. DES II (6/19; 31.6% vs. 25/92; 27.2%, p = 0.325). Stainless steel (24/135; 17.8%) and cobalt-chromium (23/121;19%) BMS had significantly lower incidence of ISR/ISO, as compared to platinum-chromium (7/18; 38.9%), p = 0.034. ISR/ISO was associated with age (p = 0.01) and CRP level > 5 mg/l (p = 0.043), while greater stent length was associated with ISR only in the DES group (p = 0.024). Conclusions Our results do not support significant differences in ISR/ISO rates between DES and BMS, although differences between particular stent types and ISR rates require further investigation.
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Risk Factors for Restenosis After Stenting or Angioplasty of Vertebral Artery Origin. Clin Neuroradiol 2019; 30:355-362. [DOI: 10.1007/s00062-019-00768-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
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Wei L, Chen Q, Li Z. Influences of plaque eccentricity and composition on the stent–plaque–artery interaction during stent implantation. Biomech Model Mechanobiol 2018; 18:45-56. [DOI: 10.1007/s10237-018-1066-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/27/2018] [Indexed: 11/29/2022]
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Chen W, Huang F, Li M, Jiang Y, He J, Li H, Dai Z, Shi W, Zhu M, Chen G, Yang F, Zhang R. Incidence and Predictors of the In-stent Restenosis after Vertebral Artery Ostium Stenting. J Stroke Cerebrovasc Dis 2018; 27:3030-3035. [PMID: 30093203 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/27/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The incidence and predictors for in-stent restenosis (ISR) was not fully explored. We aim to investigate the incidence and predictors of ISR after stenting at the origin of vertebral artery. MATERIALS AND METHODS Two hundred and six patients with 229 stents implantation between July 1, 2005 and July 31, 2015 were included in the study. All patients underwent conventional clinical and angiographic (digital subtraction angiography) follow-up at around 6 months post procedure. ISR was defined as greater than 50% stenosis within or immediately (within 5 mm) adjacent to the stent. Multivariate Cox regression analyses were utilized to investigate the predictors for ISR. RESULTS The ISR was found in 30 patients (30/206, 14.6%) with 31 lesions (31/229, 13.5%) with the mean follow-up duration of 11.1-month (range: 3 - 92 months). Stent diameter (hazard ratio 0.504, 95% confidence interval 0.294 - 0.864) was an independent predictor for ISR. CONCLUSION ISR rate after Vertebral artery ostium stent placement is acceptable, which was conversely associated with the stent diameter.
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Affiliation(s)
- Wanhong Chen
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province 210002; Department of Neurology, Xi'an XD group hospital, Xi'an, Shanxi Province 710077, China
| | - Fang Huang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province 210002
| | - Min Li
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province 210002
| | - Yongjun Jiang
- Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province 510260
| | - Jianbo He
- Department of Neurology, Xi'an XD group hospital, Xi'an, Shanxi Province 710077, China
| | - Huiqi Li
- Department of Neurology, Xi'an XD group hospital, Xi'an, Shanxi Province 710077, China
| | - Zheng Dai
- Department of Neurology, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province 214023
| | - Wei Shi
- Department of Intensive Care Unit, The Affiliated Brain Hospital with Nanjing Medical University, Nanjing, Jiangsu Province 210009
| | - Mingyue Zhu
- Department of Intensive Care Unit, The Third Affiliated Hospitial of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province 210001, China
| | - Guanghui Chen
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province 210002
| | - Fang Yang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province 210002.
| | - Renliang Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province 210002.
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Wang J, Zhong C, Zhang Y, Wei Y, Liu H, Wu C, Yan Y. Seven years' follow-up of comparative study between stenting and medication for treatment of symptomatic vertebrobasilar artery stenosis. Interv Neuroradiol 2017; 24:43-50. [PMID: 29058985 DOI: 10.1177/1591019917736032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Endovascular stent-assistant angioplasty (ESAA) is a valid treatment for symptomatic vertebrobasilar artery stenosis (SVAS), but the long-term effect and the improvement of condition compared with medication treatment are unknown. This study investigated the long-term efficacy of ESAA in patients with moderate and severe SVAS, and compared the efficacy with medication treatment. Materials and methods We conducted a retrospective analysis of clinical data of 43 patients with moderate and severe SVAS hospitalized in our department. According to different treatment methods they were divided into 29 cases in an ESAA group and 14 cases in a medication treatment group. During the follow-up period, the degree of vascular stenosis, vascular blood flow velocity, restenosis rate, recovery of neurological function and the incidence of cerebral ischemic events in the two groups were analyzed. Results The average clinical follow-up period was 89.4 ± 10.2 months. Before treatment, the stenosis rate and average blood flow velocity of the two groups were not statistically significant ( p > 0.05). During the follow-up period, both were significantly lower than the medication treatment group ( p < 0.01). In the ESAA group, three cases of stent stenosis, and three cases in the medication treatment group were completely occluded. The total ischemic events in ESAA group were three cases, compared with nine cases in the medication treatment group; the difference was statistically significant ( p < 0.05). Conclusion ESAA has a long-term effect in the treatment of symptomatic moderate and severe vertebrobasilar artery stenosis. It is superior to medication therapy in preventing posterior circulation ischemia (PCI), but a larger sample size is still needed to confirm the study.
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Affiliation(s)
- Jun Wang
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Changyang Zhong
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Yan Zhang
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Yingnan Wei
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Huili Liu
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Chunli Wu
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
| | - Yongxing Yan
- Department of Neurology, Hangzhou Clinical College of Medical University of Anhui; Hangzhou Third Hospital, Hangzhou, P.R. China
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Tang X, Tang F, Hu C, Wang Q, Long W, Li L. Dynamic Respiratory Tortuosity of the Vertebral Artery Ostium. J Endovasc Ther 2016; 24:124-129. [PMID: 27831484 DOI: 10.1177/1526602816676254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the prevalence of dynamic respiratory tortuosity (DRT) of the vertebral artery ostium (VAO) as well as to evaluate its correlation with in-stent restenosis (ISR) and stent fracture. METHODS From March 2012 to June 2015, 178 consecutive patients (mean age 65.2±5.8 years; 124 men) with symptoms of atherosclerotic vertebrobasilar ischemia underwent angiography prior to stent implantation in the vertebral, subclavian, and/or carotid arteries. In this cohort, 54 patients (mean age 67.3±5.3 years; 40 men) had VAO stent implantation. Angiography of the vertebral artery was recorded in 2 phases with breath-hold: deep inspiration (DIP) and deep expiration (DEP). Obvious VAO tortuosity was defined as any VAO angle ≤120° in DIP. Obvious VAO-DRT was defined as any VAO angle increasing ≥60° from DIP to DEP. Computed tomography angiography (CTA) or digital subtraction angiography was used in follow-up to detect ISR and stent fracture. RESULTS Of the 178 patients in this study, 21 (11.8%) had obvious VAO tortuosity and 8 (4.5%) had obvious VAO-DRT. Two of the 21 patients with obvious VAO tortuosity also had obvious VAO-DRT. Three of the 54 VAO stent patients had VAO-DRT. There were no correlations between VAO-DRT and age, sex, risk factors, body mass index, chronic obstructive pulmonary disease, asthma, or obvious VAO tortuosity (p>0.05). Over a mean follow-up of 28±10 months, there were 4 (7.4%) asymptomatic VAO ISR cases. Two (3.7%) were occlusions at 6 and 12 months, respectively; both were associated with stent fracture in patients with obvious VAO-DRT before stenting. Both stents fractured at the tortuous VAO region. VAO-DRT was correlated with stent fracture (Spearman ρ=0.81, p<0.01) and ISR (Spearman ρ=0.55, p<0.01). CONCLUSION VAO-DRT could be a risk factor for stent fracture and restenosis after VAO stent implantation. Angiography in both inspiration and expiration phases, especially the latter, should be considered before VAO stenting. Using a shorter stent to avoid crossing the tortuosity could reduce the occurrence of fracture.
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Affiliation(s)
- Xiaobin Tang
- 1 Vascular Surgery Department, Beijing Anzhen Hospital, Beijing, China
| | - Feng Tang
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Chang Hu
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Qian Wang
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Whitney Long
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
| | - Lei Li
- 2 Vascular Department, First Hospital of Tsinghua University, Beijing, China
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Ren X, Qiao A, Song H, Song G, Jiao L. Influence of Bifurcation Angle on In-Stent Restenosis at the Vertebral Artery Origin: A Simulation Study of Hemodynamics. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0155-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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13
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Geng X, Hussain M, Du H, Zhao L, Chen J, Su W, Ma L, Gao Z, Ding Y, Ji X. Comparison of self-expanding stents with distal embolic protection to balloon-expandable stents without a protection device in the treatment of symptomatic vertebral artery origin stenosis: a prospective randomized trial. J Endovasc Ther 2015; 22:436-444. [PMID: 25862360 DOI: 10.1177/1526602815579406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the angiographic and clinical outcomes of self-expanding stents (SES) with distal embolic protection devices (EPD) vs balloon-expandable stents (BES) without EPD in the treatment of symptomatic atherosclerotic vertebral artery ostial stenosis (VAOS). METHODS Between July 2011 and March 2013, a prospective randomized trial was conducted involving 127 patients (mean age 67.3±10.2 years; 94 men) with symptomatic VAOS randomly assigned to treatment with SES + EPD (Precise RX or RX Acculink stent + Spider FX EPD; n=61) or BES (Palmaz Blue or Resolute RX; n=66) without EPD. In-stent restenosis (ISR) >50% detected by duplex ultrasound was the primary endpoint. Technical success, clinical success, complications within 30 days, and signal intensity abnormalities on diffusion weighted imaging (DWI) after stenting were compared. RESULTS The 30-day technical success rate was 95.5% (63/66) for SES+EPD vs 100% (70/70) for BES without EPD (p=0.072). DWI at 24 hours poststenting showed 2 hyperintense lesions in 2 (3.3%) SES + EPD cases and 15 hyperintense lesions in 13 (18.6%) BES patients (p<0.01). At a mean 18-month follow-up, the clinical success rate was 93.9% (62/66) for the SES + EPD group vs 85.7% (60/70) for the BES group (p=0.115). The ISR was seen in 16/70 (22.9%) arteries in the BES group and 2/66 (3.1%) arteries in SES + EPD group (p<0.01). Target vessel revascularization was performed in 7 (10.0%) BES arteries vs none in the SES + EPD group (p<0.01). CONCLUSION SES with EPD in the treatment of symptomatic VAOS is technically feasible and safe, with low rates of ISR and significantly reduced thromboembolic events on imaging when compared to BES without EPD.
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Affiliation(s)
- Xiaokun Geng
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mohammed Hussain
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Huishan Du
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China
| | - Liang Zhao
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Vascular Surgery, Luhe Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Su
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linlin Ma
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China
| | - Zongen Gao
- Department of Neurology, Central Hospital of Shengli Oilfield, Dongying, China
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Alaraj A, Wallace A, Dashti R, Patel P, Aletich V. Balloons in endovascular neurosurgery: history and current applications. Neurosurgery 2014; 74 Suppl 1:S163-90. [PMID: 24402485 DOI: 10.1227/neu.0000000000000220] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The use of balloons in the field of neurosurgery is currently an essential part of our clinical practice. The field has evolved over the last 40 years since Serbinenko used balloons to test the feasibility of occluding cervical vessels for intracranial pathologies. Since that time, indications have expanded to include sacrificing cervical and intracranial vessels with detachable balloons, supporting the coil mass in wide-necked aneurysms (balloon remodeling technique), and performing intracranial and cervical angioplasty for atherosclerotic disease, as well as an adjunct to treat arteriovenous malformations. With the rapid expansion of endovascular technologies, it appears that the indications and uses for balloons will continue to expand. In this article, we review the history of balloons, the initial applications, the types of balloons available, and the current applications available for endovascular neurosurgeons.
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Affiliation(s)
- Ali Alaraj
- Department of Neurosurgery, College of Medicine, University of Illinois at Chicago. Chicago, Illinois
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Qiao A, Zhang Z. Numerical Simulation of Vertebral Artery Stenosis Treated With Different Stents. J Biomech Eng 2014; 136:1789553. [DOI: 10.1115/1.4026229] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 12/12/2013] [Indexed: 11/08/2022]
Abstract
We sought to investigate the effects of endovascular stents with different links for treating stenotic vertebral artery and to determine the relationship between the shape of the link and in-stent restenosis (ISR). We also attempted to provide scientific guidelines for stent design and selection for clinical procedures. Models of three types of stent with different links (L-stent, V-stent, and S-stent) and an idealized stenotic vertebral artery were established. The deployment procedure for the stent in the stenotic vertebral artery was simulated for solid mechanics analysis. Next, the deformed models were extracted to construct the blood flow domain, and numerical simulations of the hemodynamics in these models were performed using the finite element method. The numerical results demonstrated that: (1) Compared with the L-stent and V-stent, the S-stent has a better flexibility and induces less stress in the stent strut. Furthermore, less stress is generated in the arterial wall. (2) Vascular straightening is scarcely influenced by the shape of the link, but it is closely related to the flexibility of the stent. (3) The S-stent has the smallest foreshortening among the three types of stents. (4) Compared with the V-stent and S-stent, the L-stent causes a smaller area with low wall shear stress, less blood stagnation area, and better blood flow close to the artery wall. From the viewpoint of the combination of solid mechanics and hemodynamics, the S-stent has better therapeutic effects because of its lower potential for inducing ISR and its better prospects in clinical applications compared with the L-stent and V-stent.
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Affiliation(s)
- Aike Qiao
- Mem. ASME College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China e-mail:
| | - Zhanzhu Zhang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing 100124, China e-mail:
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Brasiliense LBC, Albuquerque FC, Spetzler RF, Hanel RA. Advances and Innovations in Revascularization of Extracranial Vertebral Artery. Neurosurgery 2014; 74 Suppl 1:S102-15. [DOI: 10.1227/neu.0000000000000218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Revascularization of the extracranial vertebral artery has evolved significantly since the adoption of endovascular techniques. The current neurosurgical armamentarium includes microsurgical and endovascular approaches. The indications for each treatment modality, however, still need to be further delineated. In contrast to carotid artery endarterectomy and carotid artery angioplasty/stenting, there is limited comparative evidence on the efficacy of medical, open, and endovascular treatment of atherosclerotic disease of the extracranial vertebral artery. More recently, drug-eluting stents have gained momentum after high rates of in-stent restenosis have been reported with bare metal stents placed in the vertebral artery. In this article, we discuss the indications, clinical assessment, and surgical nuances of microsurgical and endovascular revascularization for atherosclerotic disease of the extracranial vertebral artery. Despite a general tendency to consider endovascular treatment in the majority of patients, ultimately, open and endovascular revascularization of extracranial vertebral artery should be regarded as complementary therapies and both treatment options need to be discussed in selected patients.
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Affiliation(s)
| | - Felipe C. Albuquerque
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F. Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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NIU JING, QIAO AIKE, JIAO LIQUN. HEMODYNAMIC ANALYSIS OF STENT EXPANSION RATIO FOR VERTEBRAL ARTERY OSTIAL STENOSIS INTERVENTION. J MECH MED BIOL 2013. [DOI: 10.1142/s0219519413500589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Stents have been used successfully for treating stenosis in the vertebral artery ostium. The size of stent is found to be an important link in stent design, implantation strategy, and clinical outcome. However, there is no direct evidence of a relationship between stent expansion ratio and the stented artery. This study investigated the influence of stent expansion ratio on local hemodynamics (such as pressure distribution and pressure gradient) of vertebral artery ostial stenosis to determine a possible biomechanical mechanism. Computer-aided design of models with stents with different expansion ratios (i.e., 1.00, 1.125, and 1.25) and internal flow fields were created. All the models were meshed and simulated using computational fluid dynamics (CFD) tools. The comparisons of pressure distribution and pressure gradient are specifically presented. The results showed that the pressures increase and the pressure gradient decreases after stent implantation. The mean pressure at the stented region rises significantly with the increase of stent oversize. The heterogeneity of the pressure gradient was reduced at the stented region in the case with the expansion ratio of 1.125, whereas this effect was not obvious in other expansion ratio cases. Additionally, the combination of higher pressure and a lower pressure gradient in the case with the expansion ratio of 1.125 was significantly observed. This study demonstrated that the proper size of stent, especially with regards to the expansion ratio, is an important factor influencing the treatment of vertebral artery ostial stenosis. It is the recognition of the necessity to consider the relationship between expansion ratio and stenosis in vertebral artery ostium. These findings could help to address the optimization of hemodynamic performance for stent implantation.
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Affiliation(s)
- JING NIU
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, P. R. China
| | - AI-KE QIAO
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, P. R. China
| | - LI-QUN JIAO
- Beijing Xuanwu Hospital (affiliated to Capital Medical University), Beijing 100053, P. R. China
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Kocak B, Korkmazer B, Islak C, Kocer N, Kizilkilic O. Endovascular treatment of extracranial vertebral artery stenosis. World J Radiol 2012; 4:391-400. [PMID: 23024840 PMCID: PMC3460226 DOI: 10.4329/wjr.v4.i9.391] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/03/2012] [Accepted: 09/10/2012] [Indexed: 02/06/2023] Open
Abstract
Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery (VA) stenosis seems a safe, effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation, with a low complication rate and good long-term results. In patients with severe tortuosity of the vessel, stent placement is a real challenge. The new coronary balloon-expandable stents may be preferred. A large variability of restenosis rates has been reported. Drug-eluting stents may be the solution. After a comprehensive review of the literature, it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible, but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.
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Dumont TM, Kan P, Snyder KV, Hopkins LN, Levy EI, Siddiqui AH. Stenting of the vertebral artery origin with ostium dilation: technical note. J Neurointerv Surg 2012; 5:e36. [DOI: 10.1136/neurintsurg-2012-010360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Samaniego EA, Linfante I, Dabus G. Techniques for the diagnosis of vertebral artery origin stenosis and considerations for determining treatment and timing. Interv Cardiol 2012. [DOI: 10.2217/ica.12.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Antoniou GA, Murray D, Georgiadis GS, Antoniou SA, Schiro A, Serracino-Inglott F, Smyth JV. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg 2012; 55:1167-77. [PMID: 22206680 DOI: 10.1016/j.jvs.2011.09.084] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 09/06/2011] [Accepted: 09/24/2011] [Indexed: 01/23/2023]
Abstract
BACKGROUND Atherosclerotic occlusive disease of the proximal vertebral artery is an important cause of cerebrovascular ischemic events with a significant associated morbidity and mortality. Endovascular treatment has emerged as a promising tool of the therapeutic armamentarium, along with medical therapy and surgical reconstruction. Our objective was to systemically review the pertinent evidence on the endovascular management of proximal vertebral artery disease and perform an analysis of the published outcomes. METHODS A systematic review of the literature identified all studies reporting percutaneous transluminal angioplasty or stenting, or both, for proximal vertebral artery stenosis. Web-based search engines were searched using the Medical Subject Headings terms "vertebral artery," "angioplasty," and "stents" in all possible combinations. Studies comprising a series of at least five patients were considered for analysis. Periprocedural transient ischemic attack and stroke and death from any cause ≤30 days of treatment were defined as the primary outcome end points. RESULTS One randomized controlled trial comparing angioplasty and stenting of the proximal vertebral artery and medical therapy was identified. No comparative studies of endovascular treatment and open surgical repair were found. Forty-two selected studies reported endovascular treatment (angioplasty or stenting, or both) of 1117 vertebral arteries in 1099 patients. The weighted mean technical success rate was 97% (range, 36%-100%). Periprocedural transient ischemic attack occurred in 17 patients (1.5%). The combined stroke and death rate was 1.1%. Recurrent symptoms of vertebrobasilar insufficiency developed in 65 of 967 patients (8%) within a reported follow-up of 6 to 54 months. Restenosis developed in 183 of 789 patients (23%) who underwent follow-up imaging (range, 0%-58%). Reintervention for recurrent disease during follow-up occurred in 86 patients (9%; range, 0%-35%). CONCLUSIONS There is limited comparative evidence on the efficacy of medical, surgical, and endovascular treatment of proximal vertebral artery disease. Percutaneous transluminal angioplasty and stenting has low periprocedural neurologic adverse events and mortality.
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Affiliation(s)
- George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
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Edgell RC, Zaidat OO, Gupta R, Abou-Chebl A, Linfante I, Xavier A, Nogueira R, Alshekhlee A, Kalia J, Etezadi V, Aghaebrahim N, Jovin T. Multicenter study of safety in stenting for symptomatic vertebral artery origin stenosis: results from the Society of Vascular and Interventional Neurology Research Consortium. J Neuroimaging 2011; 23:170-4. [PMID: 22211776 DOI: 10.1111/j.1552-6569.2011.00665.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of vertebral artery origin angioplasty and stenting for stroke prevention in a multicenter clinical experience. METHODS Patients with symptomatic vertebral artery origin stenosis (VAOS) were gathered from the Society of Vascular and Interventional Neurology Research Consortium. Demographic, clinical, and procedural data were collected. The main outcome measure was procedural and peri-procedural risks of stroke, transient ischemic attack (TIA), or death at 1 and 3 months. Logistic regression analysis was used to assess covariates associated with future restenosis. RESULTS A total of 148 patients were included with mean age of 66.2 ± 11.5; 74% men and 77% Caucasian. One patient (.8%) had a stroke at 1 month and 5 of 96 (5.2%) patients had TIA at 3 months. There were no immediate procedural events or deaths. The mean angiographic pre-treatment stenosis was 80.5 ± 12.7%, which was reduced to 5.3 ± 9.1% after stent deployment. Follow-up angiography showed 15.5% of patients had significant restenosis (≥50%). Predictors of restenosis included age (OR 3.08; 95% CI 1.01, 9.41) and smoking (OR 3.10; 95% CI 1.12, 8.64). CONCLUSIONS Endovascular intervention of VAOS is associated with low peri-procedural complication rates. Restenosis remains a concern; age and smoking predicted future restenosis.
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Affiliation(s)
- Randall C Edgell
- Society of Vascular and Interventional Neurology Research Consortium at Saint Louis University, Department of Neurology and Psychiatry, Saint Louis, MO 63104. USA
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Wajnberg E, Rodrigues G, Abud DG. O uso de stents farmacológicos no tratamento da estenose das artérias vertebrais. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000600003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Relatar a viabilidade e segurança da angioplastia transluminal percutânea com stents recobertos com paclitaxel para tratamento de estenose de artéria vertebral em 14 pacientes, após seguimento de dois anos. MATERIAIS E MÉTODOS: Catorze pacientes com idade média de 67,2 anos foram submetidos a tratamento endovascular mediante angioplastia percutânea e implante de stent farmacológico. O objetivo primário deste trabalho foi assegurar a segurança do procedimento. O desfecho secundário foi a eficácia clínica, definida como sintomas isquêmicos recorrentes e taxas de reestenose. RESULTADOS: O grau de estenose variou de 50% a 99% (média de 73,3% ± 10,9). A taxa de sucesso técnico da angioplastia foi de 100%. Não houve complicações diretamente relacionadas ao procedimento. Aos 24 meses de seguimento, nenhum paciente apresentou recorrência dos sintomas. A taxa de reestenose intra-stent foi de 7,1%, embora tenha sido assintomática na totalidade dos casos. CONCLUSÃO: Este estudo sugere que a angioplastia da artéria vertebral com o uso de stents recobertos com paclitaxel é uma técnica viável e promissora em termos de segurança e eficácia na prevenção da isquemia recorrente e reestenose.
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Stayman AN, Nogueira RG, Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke 2011; 42:2212-6. [PMID: 21700936 DOI: 10.1161/strokeaha.110.611459] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 02/25/2011] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Extracranial vertebral artery stenosis (ECVAS) is common among patients with ischemic stroke. Despite the limited knowledge of the natural history of patients with symptomatic vertebral disease, endovascular revascularization techniques are now utilized in clinical practice. We sought to determine the risk of endovascular treatment for ECVAS with a systematic review of the literature. METHODS A search strategy was used using the terms "stenting," "vertebral," "ostium," "origin," and "extracranial" through Medline. All articles were reviewed along with their references to determine the risk and durability of endovascular treatment. RESULTS A total of 27 articles were identified that met inclusion criterion, with a total of 980 of 993 patients treated with stents. The majority of patients (56%) were noted to have contralateral vertebral artery stenosis or occlusion and 92% were symptomatic at the time of treatment. A total of 11 patients (1.1%) experienced a stroke and 8 (0.8%) experienced a transient ischemic attack within 30 days of the procedure. Drug-eluting stents were associated with lower restenosis rates (11%) compared to bare metal stents (30%) at a mean of 24 months of follow-up. CONCLUSIONS Stenting and angioplasty of ECVAS appear to have a low rate of periprocedural stroke or transient ischemic attack and restenosis rates that may not be as high as suspected. Given the frequency of ECVAS as an etiology for ischemic stroke, future studies aimed at determining efficacy of this treatment modality relative to medical therapy would be of benefit to clinicians caring for these patients.
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Affiliation(s)
- Aaron N Stayman
- Departments of Neurolog, Vanderbilt University School of Medicine, Nashville, TN, USA
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Vertebral Artery Origin Stenosis and its Treatment. J Stroke Cerebrovasc Dis 2011; 20:369-76. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 04/25/2011] [Accepted: 05/04/2011] [Indexed: 01/28/2023] Open
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Hatano T, Tsukahara T, Miyakoshi A, Arai D, Yamaguchi S, Murakami M. Stent placement for atherosclerotic stenosis of the vertebral artery ostium: angiographic and clinical outcomes in 117 consecutive patients. Neurosurgery 2011; 68:108-16; discussion 116. [PMID: 21099720 DOI: 10.1227/neu.0b013e3181fc62aa] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although it is thought to be a safe treatment option, the main concerns related to treating vertebral artery ostium (VAO) stenosis with stents have been the rate of restenosis and the uncertain long-term results. OBJECTIVE To evaluate the angiographic and clinical results of stent placement for atherosclerotic stenosis of the VAO. METHODS One hundred seventeen consecutive patients with atherosclerotic VAO stenosis were treated with stent placement over a period of 12 years. All patients were retrospectively analyzed through the use of a prospectively collected database. The indication criteria for this treatment protocol were symptomatic severe VAO stenoses (> 60%) and asymptomatic severe VAO stenoses (> 60%) with incidentally detected infarction in the posterior circulation. The target diameter of stent dilatation from 1997 to 2000 was the normal vessel diameter just distal to the lesion. Moderate overdilation in the proximal portion of the stents has been performed since 2001. RESULTS Successful dilatation was obtained in 116 of 117 cases. Transient neurological complications developed in 2 patients; however, no patients experienced any permanent neurological complications. One hundred four patients underwent follow-up angiography at 6 months after stenting. The restenosis rate at the 6-month follow-up was 9.6% (10 of 104). Until 2000, the restenosis rate after stenting was 13.3%. Since 2001, the restenosis rate has decreased to 4.5%. The median clinical follow-up period was 48 months. The annual rate of strokes in the posterior circulation was 0.95%. CONCLUSION Stent placement for atherosclerotic VAO stenosis is considered to be a feasible and safe treatment and may be effective for stroke prevention. The moderate overdilation of stents may be an effective modality for the prevention of restenosis.
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Affiliation(s)
- Taketo Hatano
- Department of Neurosurgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
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Influence of vessel size and tortuosity on in-stent restenosis after stent implantation in the vertebral artery ostium. Cardiovasc Intervent Radiol 2010; 34:481-7. [PMID: 20683721 DOI: 10.1007/s00270-010-9953-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 07/07/2010] [Indexed: 12/13/2022]
Abstract
PURPOSE Percutaneous transluminal angioplasty and stenting is emerging as an alternative for treating atherosclerotic stenosis in the vertebral artery ostium. However, in-stent restenosis (ISR) still remains a critical issue to be addressed. Little is known about the relationship between anatomic characteristics of the artery and ISR after stent implantation. In this study, we have evaluated influential factors for ISR in a cohort of the patients with stenting in the vertebral artery ostium. METHODS Sixty-one patients with 63 symptomatic lesions in vertebral artery ostium treated with stenting were enrolled onto this study. An average of 12.5 months' clinical and angiographic follow-up results were analyzed retrospectively. The possible influential factors for ISR, including conventional risk factors of cerebrovascular diseases and morphological characteristics of target lesions, were evaluated by univariate and multivariate regression analysis. RESULTS Technical success was achieved in all 63 interventional procedures. Stenosis was reduced from (mean±standard deviation) 75.5±12% before to 1±3.6% after the procedure. During the mean 12.5-month angiographic follow-up, ISR was detected in 17 treated vessels (27.0%), with 2 treated arteries (3.2%) resulting in occlusion, and a stent fracture in 1 case (1.6%). Multivariate Cox regression analysis showed that the tortuosity of V1 (hazard ratio 3.54, P=0.01) and smaller diameter of the stent (hazard ratio 3.8, P=0.04) were independent predictors of ISR. CONCLUSIONS Angioplasty and stenting for symptomatic stenosis in the vertebral artery ostium stenosis seem to be feasible and effective. Tortuosity and smaller diameter may affect ISR after stent implantation.
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Bain M, Hussain MS, Gonugunta V, Moskowitz S, Hui FK, Gupta R. Indirect Reperfusion in the Setting of Symptomatic Carotid Occlusion by Treatment of Bilateral Vertebral Artery Origin Stenoses. J Stroke Cerebrovasc Dis 2010; 19:241-246. [PMID: 20434054 DOI: 10.1016/j.jstrokecerebrovasdis.2009.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 03/14/2009] [Accepted: 03/26/2009] [Indexed: 10/19/2022] Open
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Werner M, Bräunlich S, Ulrich M, Bausback Y, Schuster J, Lukhaup A, Botsios S, Scheinert D, Schmidt A. Drug-Eluting Stents for the Treatment of Vertebral Artery Origin Stenosis. J Endovasc Ther 2010; 17:232-40. [DOI: 10.1583/09-2904.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Edgell RC, Yavagal DR, Drazin D, Olivera R, Boulos AS. Treatment of Vertebral Artery Origin Stenosis with Anti-Proliferative Drug-Eluting Stents. J Neuroimaging 2010; 20:175-9. [DOI: 10.1111/j.1552-6569.2008.00330.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chung SY, Lee DH, Choi JW, Choi BS, In HS, Kim SM, Choi CG, Kim SJ, Suh DC. Use of self-expanding stents for the treatment of vertebral artery ostial stenosis: a single center experience. Korean J Radiol 2010; 11:156-63. [PMID: 20191062 PMCID: PMC2827778 DOI: 10.3348/kjr.2010.11.2.156] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 11/27/2009] [Indexed: 11/21/2022] Open
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.
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Affiliation(s)
- Sun Young Chung
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Vajda Z, Miloslavski E, Güthe T, Fischer S, Albes G, Heuschmid A, Henkes H. Treatment of stenoses of vertebral artery origin using short drug-eluting coronary stents: improved follow-up results. AJNR Am J Neuroradiol 2009; 30:1653-6. [PMID: 19729536 DOI: 10.3174/ajnr.a1715] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Recent studies on stent placement of significant stenoses at the origin of the vertebral artery reported excellent immediate results. Long-term outcomes, however, were disappointing due to high restenosis rates and stent breakage. In the present study, we evaluated the application of a short drug-eluting balloon-expandable coronary stent for the endovascular treatment of these frequent lesions. MATERIALS AND METHODS In a period of 23 months, 48 patients (12 women, 36 men) with a mean age of 68 years (range, 46-82 years) harboring 52 significant ostial vertebral artery stenoses underwent treatment with short (8 mm) balloon-expandable paclitaxel-eluting coronary stents. Stents were deployed as closely as possible so that the proximal end was just at the origin of the vertebral artery, with high inflation pressure applied. Patients were under continuous medication with acetylsalicylic acid and clopidogrel before and after the treatment. Follow-up clinical assessment and angiography were performed in all patients. RESULTS Periprocedural complications were not encountered. Stenosis severity was reduced from 62 +/- 2% (mean +/- standard error of the mean) preprocedurally to 15 +/- 2% postprocedurally. Follow-up angiography at 7.7 +/- 0.6 months revealed a mean stenosis degree of 24 +/- 3%. None of the patients developed posterior circulation symptoms related to the treated segment during the follow-up period. Recurrent stenosis (>50%) at follow-up was found in 6 (12%) lesions. CONCLUSIONS Stent placement of significant ostial vertebral artery stenosis by using short drug-eluting stents is safe and yields good midterm patency rates and excellent protection from posterior circulation ischemia.
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Affiliation(s)
- Z Vajda
- Clinic for Neuroradiology, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
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Parkhutik V, Lago A, Tembl JI, Aparici F, Vazquez V, Mainar E. Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: to treat or not to treat. Eur J Neurol 2009; 17:267-72. [PMID: 19765054 DOI: 10.1111/j.1468-1331.2009.02786.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Comprehensive indications for treatment of symptomatic vertebral stenosis remain unavailable. Even less is known about endovascular treatment of asymptomatic cases. We treated symptomatic and asymptomatic vertebral ostium stenosis with angioplasty and stenting and investigated the long term outcome. METHODS Consecutive patients with two different indications were included. Group 1 (G1) had symptomatic >50% stenosis. Group 2 (G2) had asymptomatic >50% stenosis and severe lesions of anterior circulation and were expected to benefit from additional cerebral blood supply. RESULTS Twenty nine vertebral origin stenoses in 28 patients (75% men, mean age 64 +/- 9 years) were treated. There were 16 G1 and 13 G2 cases. Technical success rate was 100%. Immediate neurological complications rate was 3.4% (one G1 patient with vertebral TIA due to release of emboli). Two further strokes were seen during follow up (32 +/- 24 months): vertebrobasilar stroke in a G2 patient with permeable stent in V1 segment, new ipsilateral V3 occlusion and high-risk cardioembolic source, and carotid stroke in a G1 patient who had had ipsilateral carotid stenting. There were no deaths of any cause. Asymptomatic restenosis was observed in one out of 19 patients from both groups who underwent a follow up angiography. CONCLUSIONS Angioplasty and stenting appears to be technically feasible and safe in asymptomatic and symptomatic vertebral stenosis. More studies are needed in order to clarify its role in primary and secondary prevention of vertebrobasilar stroke. High risk anterior circulation lesions should be taken into account as a possible indication in patients with asymptomatic vertebral stenosis.
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Affiliation(s)
- V Parkhutik
- Department of Neurology, Hospital Universitario La Fe, Valencia, Spain.
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Taylor RA, Siddiq F, Memon MZ, Qureshi AI, Vazquez G, Hayakawa M, Chaloupka JC. Vertebral artery ostial stent placement for atherosclerotic stenosis in 72 consecutive patients: clinical outcomes and follow-up results. Neuroradiology 2009; 51:531-9. [PMID: 19437002 DOI: 10.1007/s00234-009-0531-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 04/15/2009] [Indexed: 01/16/2023]
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.
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Affiliation(s)
- Robert A Taylor
- Zeenat Qureshi Stroke Research Center, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
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