Advances and Innovations in Revascularization of Extracranial Vertebral Artery

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S102-S115 ◽  
Author(s):  
Leonardo B. C. Brasiliense ◽  
Felipe C. Albuquerque ◽  
Robert F. Spetzler ◽  
Ricardo A. Hanel
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Treatment Options ◽  
Bare Metal Stents ◽  
Atherosclerotic Disease ◽  
Metal Stents ◽  
General Tendency ◽  
Endovascular Revascularization ◽  
Extracranial Vertebral Artery

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.

scholarly journals Comparison of drug-eluting and bare metal stents for extracranial vertebral artery stenting

2019 ◽  
Vol 15 (3) ◽  
pp. 328-337
Author(s):  
Damian Maciejewski ◽  
Piotr Pieniazek ◽  
Lukasz Tekieli ◽  
Piotr Paluszek ◽  
Tadeusz Przewlocki ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Drug Eluting ◽  
Extracranial Vertebral Artery ◽  
Vertebral Artery Stenting

Abstract WMP44: A Meta-Analysis of Drug Eluting Stents vs Bare Metal Stents for Treatment of Extracranial Vertebral Artery Disease

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Nakul Sheth ◽  
Vikas Gupta ◽  
Wenzhuan He ◽  
Shariyah Gordon ◽  
Charles J Prestigiacomo ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Clinical Success ◽  
Meta Analysis ◽  
Bare Metal Stents ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Significant Difference ◽  
Drug Eluting ◽  
Extracranial Vertebral Artery

A Meta-Analysis of Drug Eluting Stents vs. Bare Metal Stents for Treatment of Extracranial Vertebral Artery Disease Background: —Although a growing number of reports offer evidence for the potential of drug eluting stents (DES) in treating atherosclerotic stenosis of the extracranial vertebral artery, their efficacy when compared to bare metal stents (BMS) is uncertain due to the lack of a large prospective randomized trial. Methods: —A search strategy was used using the terms "stents," "drug-eluting stents," "atherosclerosis," "vertebral artery," and "vertebrobasilar insufficiency" through Medline. Five studies met the criteria for a comparative meta-analysis. The technical and clinical success, periprocedural complications, target vessel revascularization (TVR), rates of restenosis and recurrent symptoms and overall survival were compared between the DES and BMS groups using the Mantel-Haenszel method with fixed and random effect models. Results: —The mean pretreatment stenosis was 83.8±4.2% in the DES group (n = 156) and 80.12±2.7% in the BMS group (n = 148). There was no significant difference in the technical success (OR = 1.528, p = 0.622), clinical success (OR = 1.917, p = 0.274) and periprocedural complications (OR = 0.741, p = 0.614) between the two groups. The rates of technical success, clinical success and periprocedural complications were 98.78%, 95.77% and 1.94% for the DES group vs. 100%, 97.96% and 2.96% for the BMS group. There was no periprocedural mortality, stroke or TIA. The mean clinical and radiological follow-up times were 19.1±6.9 and 14.23±1.5 months respectively, for the DES arm and 26±7.6 and 20.5±3.3 months, respectively, for the BMS group. A 0.388 odds ratio of no-restenosis in the BMS to DES arms (p = 0.001) indicated a significantly higher restenosis rate in the BMS group relative to the DES group (33.57% vs. 15.49%, respectively). When compared with the DES group, the BMS group had a significantly higher rate of recurrent symptoms (2.76% vs. 11.26%; OR = 3.319, p = 0.011) and TVR (4.83% vs. 19.21%; OR = 4.099, p = 0.001). There was no significant difference between overall survival (OR = 0.655, p = 0.32). Conclusion: —A lower rate of restenosis, recurrent symptoms and target vessel revascularization was noted in the DES group.

Drug eluting stents versus bare metal stents for the treatment of extracranial vertebral artery disease: a meta-analysis

2015 ◽  
Vol 8 (8) ◽  
pp. 770-774 ◽  
Author(s):  
Vivek H Tank ◽  
Ritam Ghosh ◽  
Vikas Gupta ◽  
Nakul Sheth ◽  
Shariyah Gordon ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Clinical Success ◽  
Meta Analysis ◽  
Bare Metal Stents ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Vertebrobasilar Insufficiency ◽  
Bare Metal ◽  
Drug Eluting ◽  
Extracranial Vertebral Artery

BackgroundWhile a growing number of reports offer evidence for the potential of drug eluting stents (DES) in treating atherosclerotic stenosis of the extracranial vertebral artery, their efficacy when compared with bare metal stents (BMS) is uncertain due to the lack of a large prospective randomized trial.MethodsA search strategy using the terms ‘stents’, ‘drug-eluting stents’, ‘atherosclerosis’, ‘vertebral artery’, and ‘vertebrobasilar insufficiency’ was employed through Medline. Five studies met the criteria for a comparative meta-analysis. The technical/clinical success, periprocedural complications, target vessel revascularization (TVR), rates of restenosis, recurrent symptoms, and overall survival were compared.ResultsThere was no significant difference in the technical success (OR=1.528, p=0.622), clinical success (OR=1.917, p=0.274), and periprocedural complications (OR=0.741, p=0.614) between the two groups. An OR of 0.388 for no restenosis in the BMS to DES arms (p=0.001) indicated a significantly higher restenosis rate in the BMS group relative to the DES group (33.57% vs 15.49%). When compared with the DES group, the BMS group had a significantly higher rate of recurrent symptoms (2.76% vs 11.26%; OR=3.319, p=0.011) and TVR (4.83% vs 19.21%; OR=4.099, p=0.001).ConclusionsA significantly lower rate of restenosis, recurrent symptoms, and TVR was noted in the DES group compared with the BMS group.

Transbrachial and transfemoral approaches combined with visceral protection for the treatment of juxtarenal aortoiliac occlusive disease: Technical issues and clinical outcomes

Vascular ◽  
2021 ◽  
pp. 170853812110232
Author(s):  
Peixian Gao ◽  
Changliang Li ◽  
Xuejun Wu ◽  
Gang Li ◽  
Dianning Dong ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Bare Metal Stents ◽  
Covered Stent ◽  
Occlusive Disease ◽  
Metal Stents ◽  
Infrarenal Aorta ◽  
Bare Metal ◽  
Stent Grafts ◽  
Aortoiliac Occlusive Disease

Purpose To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period. Methods In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection. Results A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts ( n = 7), kissing bare-metal stents ( n = 2), covered stent grafts ( n = 2), bare-metal stents ( n = 1), or the off-label use of iliac limb stent grafts ( n = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1–54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan–Meier method. Conclusions Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.

Abstract TP127: Prevalence and Clinical Significance of Asymptomatic Extracranial Vertebral Artery Disease in Patients With Symptomatic Internal Carotid Artery Stenosis: Analysis of Stent-protected Angioplasty versus Carotid Endarterectomy (SPACE) Trial

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Saqib A Chaudhry ◽  
Peter A Ringleb
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Vertebral Artery Stenosis ◽  
Extracranial Vertebral Artery ◽  
Artery Disease

Background: Extracranial vertebral artery disease is seen in patients with internal carotid artery stenosis although the clinical significance not well understood. Methods: We analyzed data that was collected as part of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial which recruited patients with recently symptomatic internal carotid artery stenosis. We used Cox proportional hazards analysis to compare the relative risk of various endpoints between the three categories of extracranial vertebral artery disease (normal/hypoplastic, moderate/severe stenosis, and occlusion). The multivariate analyses were adjusted for age, gender, basic demographics and severity of carotid stenosis. Results: Of the 1181 subjects who had extracranial vertebral artery ultrasound evaluation, moderate to severe stenosis and occlusion of one of both extracranial vertebral arteries was diagnosed in 152(12.9%) and 57(4.8%) subjects, respectively. During the mean follow up period (±SD) of 22.1±7.1 months 102(8.6%) and 60(5.1%) experienced a stroke or died, respectively. Compared with subjects with normal or hypoplastic vertebral artery, there was a non-significant 30% higher risk of any stroke among subjects with moderate to severe vertebral artery stenosis (relative risk [RR]1.3, 95% confidence interval [CI]0.7-2.3) after adjusting for potential confounders. There was a 40% and 50% higher risk of ipsilateral stroke (RR 1.4, 95% CI0.7-2.5) and death (RR 1.5, 95% CI 0.7-3.1) among subjects with moderate to severe vertebral artery stenosis after adjusting for potential confounders. In Kaplan Meir analysis, the estimated 1 and 2 year stroke free survival for subjects with moderate to severe vertebral artery stenosis was 88% (standard error [SE]2.6%). In comparison, the estimated 1 and 2 year stroke free survival for subjects with normal or hypoplastic vertebral artery was 92.5%(SE0.8%)and 91.6%(SE0.9), respectively. Conclusions: There appears to be an increased risk of stroke and death in patients with symptomatic internal carotid artery stenosis with concurrent asymptomatic extracranial vertebral artery stenosis.

scholarly journals Cilostazol plus clopidogrel in the prevention of in-stent stenosis after vertebral artery origin stenting in gout patients: three case reports

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096580
Author(s):  
Huai-Wu Yuan ◽  
Ya-Jie Lin ◽  
Ren-Jie Ji
Keyword(s):  
Vertebral Artery ◽  
Case Reports ◽  
Bare Metal Stents ◽  
Computed Tomographic Angiography ◽  
Metal Stents ◽  
Computed Tomographic ◽  
History Of ◽  
Tomographic Angiography ◽  
Age Range ◽  
Stent Stenosis

It is unclear whether cilostazol instead of aspirin in combination with clopidogrel could prevent in-stent thrombosis in patients with a history of gout undergoing vertebral artery origin stenting. Three men (age range, 58–74 years) were diagnosed with acute ischaemic stroke or transient ischaemic attack. Vertebral artery origin stenosis was visible by computed tomographic angiography or digital subtraction angiography. Four bare metal stents were placed in the vertebral artery origin. The patients were administered 100 mg cilostazol orally twice a day and 75 mg clopidogrel orally once a day perioperatively and 100 mg cilostazol orally twice day was administered indefinitely after 3 months. No in-stent stenosis was observed in all of these patients during a follow-up period up to 19 months. Cilostazol plus clopidogrel has the potential to become an alternative to standard dual antiplatelet therapy in vertebral artery origin stenting. A high-quality clinical trial is needed to verify these preliminary findings.

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