Stent placement for vertebral artery occlusive disease: preliminary clinical experience.

Symptoms of vertebrobasilar insufficiency may precede neurological sequelae in up to 50% of patients. Although select patients may benefit from microsurgical revascularization, combined perioperative morbidity and mortality rates can be as high as 20%. The authors present their preliminary clinical experience using stent placement for symptomatic vertebral artery (VA) occlusive disease. Six patients with clinical symptoms of vertebrobasilar insufficiency in whom VA stents were placed from 1995 to 1998 were identified. Diagnostic four-vessel cerebral angiography identified causative stenotic, atherosclerotic lesions in all cases. A transfemoral or transradial artery approach after the patient had undergone full heparinization was chosen for endovascular stenting. Guidewire placement across the lesion followed by urokinase infusion preceded stenting. Prestent angioplasty was performed in two patients. Following the procedure, all patients were maintained on daily antiplatelet therapy. Patient age ranged from 45 to 76 years (average 63 years). Four patients were men and two were women. Angiography revealed greater than 95% stenosis in five patients and greater than 70% stenosis in one. Three patients had complete occlusion of the contralateral VA; in one other, the VA supplied only the posterior inferior cerebellar artery; and the remaining two patients had VAs with greater than 70% stenosis. Ten stents were placed in six patients for five VA origin lesions and one distal VA stenosis. A VA dissection occurring poststenting was treated by placement of three additional stents. One patient had transient double vision. All had resolution of their presenting symptoms. Follow up ranged from 1 to 24 months (average 8.4 months). Angiograms obtained in four patients at least 3 months postprocedure have revealed stent patency in all cases without evidence of restenosis. Vertebral artery stent placement can be safely performed and is a viable treatment option for carefully selected patients with vertebrobasilar insufficiency.

[1]  R. Berguer,et al.  A review of 100 consecutive reconstructions of the distal vertebral artery for embolic and hemodynamic disease. , 1998, Journal of vascular surgery.

[2]  M. Pessin,et al.  Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. , 1998, Archives of neurology.

[3]  G. Dorros,et al.  Stent deployment resolves a petrous carotid artery angioplasty dissection. , 1998, AJNR. American journal of neuroradiology.

[4]  R. Feldman,et al.  Use of coronary Palmaz-Schatz stent in the percutaneous treatment of vertebral artery stenoses. , 1996, Catheterization and cardiovascular diagnosis.

[5]  M. Dake,et al.  Vertebral artery stenting following percutaneous transluminal angioplasty. Technical note. , 1996, Journal of neurosurgery.

[6]  R. Higashida,et al.  Transluminal angioplasty for arteriosclerotic disease of the distal vertebral and basilar arteries. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[7]  L. Caplan.  Posterior circulation disease : clinical findings, diagnosis, and management , 1996 .

[8]  M. B. Brown,et al.  The Warfarin-Aspirin Symptomatic Intracranial Disease Study , 1995, Neurology.

[9]  G. Nesbit,et al.  Safety and efficacy of percutaneous transluminal angioplasty for intracranial atherosclerotic stenosis. , 1995, Stroke.

[10]  H. Touho.  Percutaneous transluminal angioplasty in the treatment of atherosclerotic disease of the anterior cerebral circulation and hemodynamic evaluation. , 1995, Journal of neurosurgery.

[11]  R. Higashida,et al.  Cerebral percutaneous transluminal angioplasty. , 1993, Heart disease and stroke : a journal for primary care physicians.

[12]  R. Baloh,et al.  Vertigo and the anterior inferior cerebellar artery syndrome , 1992, Neurology.

[13]  M. Hadley,et al.  Vertebrobasilar insufficiency. Part 2. Microsurgical treatment of intracranial vertebrobasilar disease. , 1987, Journal of neurosurgery.

[14]  M. Hadley,et al.  Vertebrobasilar insufficiency Part 1" Microsurgical treatment of extracranial vertebrobasilar disease , 1987 .

[15]  W. Baker,et al.  Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: The EC/IC Bypass Study Group. N Engl J Med 1985;313:1191–1200 , 1986 .

[16]  M. Dujovny,et al.  Surgical correction of lesions affecting the second portion of the vertebral artery. , 1986, Neurosurgery.

[17]  M. Dujovny,et al.  Posterior circulation revascularization. , 1982, Clinical neurosurgery.

[18]  J. Ausman,et al.  Vertebrobasilar insufficiency. A review. , 1985, Archives of neurology.

[19]  Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. , 1985, The New England journal of medicine.

[20]  W. Garraway,et al.  The Natural History of Hemispheric and Brainstem Infarction in Rochester, Minnesota , 1984, Stroke.

[21]  M. Modic,et al.  Intracranial internal carotid artery stenosis: longterm prognosis. , 1982, Stroke.

[22]  J. Ausman,et al.  Posterior circulation revascularization. Superficial temporal artery to superior cerebellar artery anastomosis. , 1982, Journal of neurosurgery.

[23]  R. Cohen,et al.  Microsurgical endarterectomy of the intracranial vertebral artery for vertebrobasilar transient ischemic attacks. , 1981, Neurosurgery.

[24]  T. Sundt,et al.  Occipital to posterior inferior cerebellar artery bypass surgery. , 1978, Journal of neurosurgery.

[25]  L. Elveback,et al.  Carotid and vertebral‐basilar transient ischemic attacks: Effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence— A population study , 1978, Annals of neurology.

[26]  Millikan Ch,et al.  Studies in cerebrovascular disease. III. The use of anticoagulant drugs in the treatment of insufficiency or thrombosis within the basilar arterial system. , 1955 .

[27]  C. Millikan,et al.  Studies in cerebrovascular disease. III. The use of anticoagulant drugs in the treatment of insufficiency or thrombosis within the basilar arterial system. , 1955, Proceedings of the staff meetings. Mayo Clinic.

[28]  S. I. Seldinger.  Catheter Replacement of the Needle in Percutaneous Arteriography , 1953, Acta radiologica.