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Vertebral Artery Origin Stents Revisited: Improved Results With PaclitaxelEluting 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

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

Author Information

Division of Neurosurgery, University of California, San Diego, San Diego, California (Park)

Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona (Fiorella) (Dashti) (Gonzalez) (McDougall) (Albuquerque)

Department of Neurosurgery and Division of Interventional Neuroradiology, University of Pennsylvania, Philadelphia, Pennsylvania (Stiefel)

Reprint requests: Felipe C. Albuquerque, MD, c/o Neuroscience Publications, Barrow Neurological Institute, 350 W Thomas Rd, Phoenix, AZ 85013. E-mail: neuropub@chw.edu

Received, March 5, 2009.

Accepted, January 15, 2010.

Copyright © by the Congress of Neurological Surgeons