Vertebral artery origin stents revisited: improved results with paclitaxel-eluting stents.


Journal Article

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>or=1 revascularization procedures. The risk of delayed stent thrombosis may necessitate lifelong dual antiplatelet medications.

Full Text

Duke Authors

Cited Authors

  • Park, MS; Fiorella, D; Stiefel, MF; Dashti, SR; Gonzalez, LF; McDougall, CG; Albuquerque, FC

Published Date

  • July 2010

Published In

Volume / Issue

  • 67 / 1

Start / End Page

  • 41 - 48

PubMed ID

  • 20568666

Pubmed Central ID

  • 20568666

Electronic International Standard Serial Number (EISSN)

  • 1524-4040

Digital Object Identifier (DOI)

  • 10.1227/01.neu.0000370010.09419.23


  • eng

Conference Location

  • United States