Introduction
: Background: Stenosis of the vertebral artery ostium (VAOS), while under‐diagnosed, is common and may cause 25% of posterior circulation infarctions. Stenting is widely employed as a secondary prevention strategy, but is associated with high rates of restenosis. Objective: To identify factors associated with higher risk of VAOS recurrence after stenting.
Methods
: A combined retrospective cohort of subjects who underwent vertebral ostial stenting at two academic hospitals: SSM Health Saint Louis University Hospital and the University of Iowa, was analyzed. The demographic profile of the subjects, medical comorbidities, periprocedural complications, 30 day complications, and change in Modified Rankin score, and radiographic follow up were analyzed using IBM SPSS Statistics version 26.
Results
: There were 80 patients who underwent vertebral artery stenting in this cohort. 72.5% (n = 58) were male, 70% (n = 56) were Caucasian. Hypertension (67.5%, n = 54) and hyperlipidemia (65%, n = 52) were the most prevalent vascular risk factors. Of these subjects, 31 underwent radiographic follow up with catheter angiography. The mean interval at which the last angiogram was performed was, 9.3 months (+/‐ 4.3). Independent samples t‐tests and univariate linear regression models revealed that four factors were identified as most associated with in‐stent restenosis: hypertension, diabetes mellitus, stent length, and post‐stent residual stenosis. When analyzed as a backwards stepwise multivariate model, stent length was the only variable that trended towards significance (t = 1.74, p = 0.09). Additionally, only 4 of the 31 patients did not have HTN and none of them had a recurrence of stenosis post‐procedure.
Conclusions
: Stent length may be associated with risk of recurrent stenosis after vertebral ostial stenting. This along with risk factors such as hypertension should be studied in future prospective studies as possible predictors of in‐stent restenosis.