Ortega-Gutierrez Santiago, Lopez Gloria V, Edgell Randall C, Mendez Aldo A, Dandapat Sudeepta, Roa Jorge A, Zevallos Cynthia B, Holcombe Andrea L, Hasan David, Derdeyn Colin P, Rossen James, Samaniego Edgar A
Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
Front Neurol. 2019 Jul 16;10:746. doi: 10.3389/fneur.2019.00746. eCollection 2019.
To report a single-center experience using drug-eluting balloon mounted stents (DES) for endovascular treatment of atherosclerotic ostial vertebral artery stenosis (OVAS). Posterior circulation is affected in up to 25% of strokes, 20% of them resulting from atherosclerotic OVAS. The optimal management of symptomatic OVAS remains controversial. DES have been introduced to improve restenosis rates. We retrospectively analyzed prospectively collected data from patients with dominant OVAS who underwent endovascular treatment with second-generation DES placement. Patient demographics, clinical presentation, comorbidities, stenosis severity, stent features, technical success, complications, and imaging follow-up were assessed. Thirty patients were treated, predominantly male (86.6%). Sixteen patients presented with an acute stroke or TIA and fourteen were treated on an elective basis due to symptomatic chronic stenosis and contralateral occlusion. Comorbidities included hyperlipidemia (83%), hypertension (70%) and prior stroke (63.3%). Mean ostial stenosis at presentation was 80 ± 14.8%. Twenty-one patients had contralateral VA involvement. DES deployment was technically successful in all patients using everolimus eluting stents in 30 lesions and zotarolimus eluting stents in two. One technical complication (stent migration) and three (10%) minor peri-procedural complications occurred. Complications included one asymptomatic ischemic infarct in the posterior circulation, one femoral artery thrombosis and one post-procedure altered mental status secondary to contrast induced neurotoxicity. Mean imaging follow-up was 8.8 months. Two (7.6%) patients had in-stent restenosis and underwent retreatment with angioplasty. There were no procedure-related mortalities. Our study confirms the feasibility of deploying DES for the treatment of ostial vertebral artery stenosis with low peri-procedural risk and low medium-term rates of re-stenosis.
报告使用药物洗脱球囊支架（DES）对动脉粥样硬化性椎动脉开口狭窄（OVAS）进行血管内治疗的单中心经验。高达25%的中风累及后循环，其中20%由动脉粥样硬化性OVAS引起。有症状的OVAS的最佳治疗方案仍存在争议。引入DES以提高再狭窄率。我们回顾性分析了前瞻性收集的接受第二代DES置入血管内治疗的优势OVAS患者的数据。评估了患者的人口统计学特征、临床表现、合并症、狭窄严重程度、支架特征、技术成功率、并发症及影像学随访情况。共治疗30例患者，以男性为主（86.6%）。16例患者表现为急性中风或短暂性脑缺血发作（TIA），14例因有症状的慢性狭窄和对侧闭塞而接受择期治疗。合并症包括高脂血症（83%）、高血压（70%）和既往中风（63.3%）。就诊时平均开口狭窄为80±14.8%。21例患者对侧椎动脉受累。使用依维莫司洗脱支架治疗30处病变、佐他莫司洗脱支架治疗2处病变，所有患者DES置入技术均成功。发生1例技术并发症（支架移位）和3例（10%）轻微围手术期并发症。并发症包括后循环1例无症状缺血性梗死、1例股动脉血栓形成和1例术后因造影剂诱导的神经毒性导致的精神状态改变。平均影像学随访时间为8.8个月。2例（7.6%）患者发生支架内再狭窄并接受血管成形术再次治疗。无手术相关死亡病例。我们的研究证实了使用DES治疗椎动脉开口狭窄的可行性，围手术期风险低，中期再狭窄率也低。
