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Neurosurgery:
doi: 10.1227/01.NEU.0000370010.09419.23
Clinical Studies

Vertebral Artery Origin Stents Revisited: Improved Results With Paclitaxel‐Eluting Stents

Park, Min S. MD; Fiorella, David MD, PhD; Stiefel, Michael F. MD, PhD; Dashti, Shervin R. MD, PhD; Gonzalez, L. Fernando MD; McDougall, Cameron G. MD; Albuquerque, Felipe C. MD

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Abstract

BACKGROUND: Vertebral origin angioplasty and stenting (VOAS) with bare metal stents is associated with a high rate of in-stent restenosis (ISR).

OBJECTIVE: We evaluated the rate of ISR after VOAS with drug-eluting stents.

METHODS: Twenty patients (15 men, 5 women; age range, 36–88 years; mean, 63.7 years) were treated for VOAS with a paclitaxel-eluting stent (Taxus Express2, Boston Scientific, Natick, Massachusetts). Stenosis at follow-up was quantified as insignificant (0%–24%), mild (25%–49%), moderate (50%–74%), and severe (75%–100%). ISR was defined using a binary criteria of > 50% stenosis at follow-up angiography.

RESULTS: All procedures were technically successful with no periprocedural complications. Follow-up angiography (range, 4–48 months; mean, 14.7 months) showed insignificant stenosis in 9 patients, mild in 6, moderate in 4, and severe in 1. In 1 patient with “moderate” stenosis, the stent migrated distally; therefore, the lesion restenosis was not within the stent. Thus, 4 of 19 patients (21%) exhibited binary moderate or severe ISR, and 5 of 20 showed restenosis at the lesion (25%). The patient with severe stenosis developed stent thrombosis > 3 years after VOAS.

CONCLUSION: VOAS with drug-eluting stents was associated with a low incidence of periprocedural complications. Although the rate of restenosis was half that seen with the use of bare metallic stents, 21% of patients still developed moderate or severe ISR. These patients may require ≥ 1 revascularization procedures. The risk of delayed stent thrombosis may necessitate lifelong dual antiplatelet medications.

Copyright © by the Congress of Neurological Surgeons

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