Stenting of vertebral artery origin atherosclerosis in high-risk patients: bare or coated? A single-center consecutive case series.

UNLABELLED: Atherosclerotic disease of the vertebrobasilar vessels is an important cause of posterior circulation infarction. Commonly, the primary atheroma forms at the origin of the vertebral arteries. We have recently treated 12 high-risk patients with dilatation and stenting of symptomatic vertebral-origin disease and report our technique and results.

METHODS: Twelve patients with proximal vertebral stents placed between 1999-2005 were identified from a computerized registry of 3,046 records. All patients had high-grade origin stenoses, symptoms of cerebral ischemia and the following additional risk factors: 6 had contralateral vertebral occlusions; 1 had bilateral carotid occlusion; 2 had combined subclavian/vertebral-origin disease. After treatment, all patients were monitored with ultrasound and angiography and were aggressively managed for vascular disease risk factors.

RESULTS: Patients had: hyperlipidemia, 90%; hypertension, 80%; tobacco use, 70%; homocysteine > 10, 50%; coronary disease, 40%; diabetes mellitus, 20%. No deaths or procedural complications occurred during the neurointerventional procedures. Drug-eluting stents (tacrolimus) were used in the last 5 cases. Three of the 7 patients treated with uncoated stents developed restenosis. Angioplasty for restenosis was durable in 2. One patient developed asymptomatic occlusion of her bare-metal stent. None of the patients treated with tacrolimus stents had recurrence of stenosis (p = 0.08). One patient died from pharyngeal cancer at 8 months, and 1 from lung cancer at 17 months.

CONCLUSIONS: In high-risk patients with vertebralorigin disease, stenting demonstrated a low procedural complication rate, a moderate restenosis rate, good long-term patency and good longterm stroke-free survival. Placement of drug-eluting stents appears to reduce in-stent restenosis.