Stent placement for atherosclerotic stenosis of the vertebral artery ostium: angiographic and clinical outcomes in 117 consecutive patients.

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.