Long-term biomechanical stability of self-expanding stents using the crossover technique for vertebral artery ostium stenosis: A tortuosity index analysis.

BACKGROUND

Vertebral artery ostium (VAO) stenosis treatment with balloon-expandable stents is challenging due to precise positioning difficulties and high rates of restenosis and fracture. Self-expanding stents (SES) using the crossover technique from VAO to proximal subclavian artery may offer better accessibility, though long-term outcomes remain unclear.

METHODS

Ten patients with symptomatic VAO stenosis underwent SES placement using the crossover technique, extending from V1 segment to proximal subclavian artery. Tortuosity index was measured from digital subtraction angiography frontal projections using automated analysis with manual correction at pre-procedure, post-procedure, and >3-year follow-up. Clinical and angiographic outcomes were evaluated.

RESULTS

Technical success was 100%. Mean tortuosity index improved from 1.15 ± 0.09 to 1.03 ± 0.03 post-procedure (P < 0.01) and remained stable at 1.02 ± 0.02 at mean 4.1-year follow-up. No restenosis occurred. One fracture (10%) occurred at an intentionally balloon-dilated site for future radial access; no unintended mechanical failures occurred (0/9).

CONCLUSION

SES crossover technique demonstrates excellent long-term structural integrity with stable vessel geometry and zero unintended fractures over >3 years in VAO treatment.