Our Experiences with Vertebral Artery Stents

Objective: This study aimed to evaluate the success and clinical outcomes of endovascular stent treatment in vertebral artery (VA)occlusive lesions.Methods: A total of 103 patients who underwent endovascular treatment due to VA constriction were included in this study. Thepatients were diagnosed on the basis of their clinical manifestations (vertigo, visual complaints, syncope, ataxia, drop attack, isch-emic stroke, and transient ischemic attack (TIA)), neurological examinations, Doppler ultrasonography examination, and digitalsubtraction angiography (DSA). For angiographic evaluation, all patients underwent four vessel angiographies including the aorticarch, VA, and carotid artery. Anterior circulation, posterior circulation, and the Willis polygon were evaluated for all patients. Duringthe procedure, the patients were not sedated, and neurological findings were continuously monitored.Results: Thirty-six patients had stents implanted in their right vertebral arteries, 16 patients in their left vertebral arteries, and 3patients in both vertebral arteries. During the procedure, bradycardia developed in three cases, and atropine was administered forits intervention. Hypotension developed in two cases, and dopamine along with 0.9% NaCl was administered for its intervention.One of the patients developed a speech disorder along with a complaint of imbalance 24 hours after the procedure. A magneticresonance imaging (MRI) examination revealed an infarct on the left posterior inferior cerebellar artery (PICA) supply area. Thepatients’ symptoms subsided with minimal sequelae. Two patients had TIAs with complaints of dizziness and weakness on the leftside. Hemorrhage and hematoma developed in the femoral artery region 2 hours after the stent implantation in two cases. Oneunit transfusion was applied.Conclusion: Vertebral artery stenosis is one of the correctable causes of posterior systemic stroke and can now be diagnosed withmore ease with the use of modern imaging methods. Balloon angioplasty or stent-assisted endovascular treatment is an effectivetreatment with low morbidity and mortality for patients with a single VA or who do not respond to medical treatment due tocerebral vascular pathology.

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Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown MM. Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Stroke 2007; 38: 1526-30.
Compter A, van der Worp HB, Schonewille WJ, Vos JA, Boiten J, Nederkoorn PJ, et al. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. Lancet Neurol 2015; 14: 606-14.
Drazyk AM, Markus HS. Recent advances in the management of symptomatic vertebral artery stenosis. Curr Opin Neurol 2018; 31: 1-7.
Markus HS, Larsson SC, Kuker W, Schulz UG, Ford L, Rothwell PM, et al. Stenting for symptomatic vertebral artery stenosis The Vertebral Artery Ischaemia Stenting Trial. Neurology 2017; 89: 1229-36.
Jenkins JS, White CJ, Ramee SR, Collins TJ, Chilakamarri VK, McKinley KL, et al. Vertebral artery stenting. Catheter Cardiovasc Interv 2001; 54: 1-5.
Savitz SI, Caplan LR. Vertebrobasilar disease. N Engl J Med 2005; 352: 2618-26.
Jenkins JS, Stewart M. Endovascular treatment of vertebral artery stenosis. Prog Cardiovasc Dis 2017; 59: 619-25.
Wehman JC, Hanel RA, Guidot CA, Guterman LR, Hopkins LN. Atherosclerotic occlusive extra cranial vertebral artery disease: indications for intervention, endovascular techniques, short-term and long-term results. J Interv Cardiol 2004; 17: 219-32.
Henry M, Polydorou A, Henry I, Polydorou A, Hugel M. Percutaneous transluminal angioplasty and stenting of extracranial vertebral artery stenosis. The Carotid and Supra-Aortic Trunks: Diagnosis, Angioplasty and Stenting, 2nd Edition, 2003; 458-72.
Patil ST, Meshram MM, Kamdi NY, Kasote AP, Parchand MP. Study on branching pattern of aortic arch in Indian. Anat Cell Biol 2012; 45: 203-6.
Stayman AN, Nogueira RG, Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke 2011; 42: 2212-6.
Motarjeme A, Keifer JW, Zuska AJ. Percutaneous transluminal angioplasty of the vertebral arteries. Radiology 1981; 139: 715-7.