Stent angioplasty in patients with vertebral artery ostial stenosis: clinical and angiographic outcomes in 525 patients.

BACKGROUND

The optimal treatment approach for patients with severe atherosclerotic vertebral artery ostial stenosis (VAOS) is not yet supported by evidence from large-scale studies. Even with optimal medical treatment and effective risk factor management, substantial numbers of patients experience symptoms or recurrent strokes. Endovascular treatment is a potential solution, particularly when medicinal therapy alone is insufficient for symptom and stroke risk reduction. This study was aimed at assessing the safety and effectiveness of stent angioplasty in patients with VAOS.

METHODS

This single-centre retrospective analysis included 564 procedures in 525 patients (symptomatic n=265, without recent symptoms n=260; 72.2% male; median age: 70 years; stenosis >75% n=371) who underwent stenting for atherosclerotic VAOS between 2008 and 2022. Vertebrobasilar tandem lesions and dissections were excluded. Digital subtraction angiography was performed in all patients during the follow-up. Patients' characteristics, periprocedural and postprocedural neurological events, and follow-up data were evaluated.

RESULTS

Stenting was successfully performed in all cases. The in-hospital stroke rate was 0.6% (disabling n=2; non-disabling n=1). No ipsilateral stroke or treatment-associated deaths occurred during a mean follow-up period of 56 months (min.-max., 9-183 months). In-stent restenosis >50% was found in 89 (15.8%) implanted stents, with the majority (70 out of 89) diagnosed within the first year, at a median time of 7 months.

CONCLUSIONS

Stent angioplasty was demonstrated to be a safe and feasible option for patients with VAOS, with a low risk of periprocedural stroke and symptom recurrence, and favourable stent patency rates at mid-term and long-term follow-up.