Self-expanding open-cell carotid stent for symptomatic moderate-to-severe vertebral artery origin atherosclerotic stenosis: a single-center retrospective study.

BACKGROUND

Open-cell self-expanding stents have been used for vertebral artery origin (VAO) atherosclerotic stenosis; however, data on their safety and durability remain limited.

METHODS

We retrospectively screened 96 patients who were evaluated for potential open-cell self-expanding stent treatment of angiographically confirmed VAO stenosis between February 2015 and December 2020. After exclusion of 62 patients (47 with vertebral artery diameter <4.0 mm and 15 with vertebral artery diameter > = 4.0 mm who declined self-expanding stent treatment), the final treated cohort comprised 34 consecutive eligible symptomatic patients who underwent open-cell self-expanding stent implantation. Clinical outcomes were assessed perioperatively and during follow-up. The 30-day safety endpoint included stroke, myocardial infarction, and death. ISR was evaluated among patients who completed imaging follow-up; DSA-confirmed ISR and ISR among all patients with imaging surveillance were both reported.

RESULTS

Of 96 screened patients, 34 symptomatic treated patients were included. Three patients entered the symptomatic 50-69% stenosis pathway after insufficient response to medical therapy, and 31 entered the symptomatic > = 70% high-risk anatomic stenosis pathway. Technical success was 100%. VAO stenosis improved from 75.7 +/- 7.9% preprocedure to 8.4 +/- 7.6% immediately after stenting (p < 0.001). Distal embolic protection was used in all procedures. Periprocedural complications occurred in 2/34 patients (5.9%; 95% CI, 1.6-19.1%), including 1 symptomatic acute cerebral infarction. No myocardial infarction or death occurred within 30 days. Clinical follow-up was available in 31/34 patients (91.2%); long-term telephone follow-up had a median duration of 43.0 months (IQR, 35.0-55.0; range, 10-83), with no treatment-requiring recurrent symptoms reported. Imaging follow-up was available in 24/34 patients (70.6%) for a median of 6.0 months (IQR, 3.8-13.5; range, 1-60). DSA-confirmed ISR occurred in 1/16 patients (6.3%; 95% CI, 1.1-28.3%) who underwent DSA follow-up; among all patients with imaging surveillance, ISR was observed in 1/24 (4.2%; 95% CI, 0.7-20.2%).

CONCLUSION

In this single-center retrospective series, open-cell self-expanding stent implantation for atherosclerotic VAO stenosis appeared technically feasible and was associated with infrequent periprocedural adverse events. Longer-term durability and optimal patient selection require confirmation in larger prospective studies with standardized imaging follow-up.