The Usage and Efficiency of Drug Eluting Stents in Vertebral Ostial Stenosis

Burcu Erkan; Serdar Geyik; Kıvılcım Yavuz; Işıl Saatçi; Saruhan Çekirge

doi:10.31067/acusaglik.850835

TR EN

Vertebral Ostial Stenoz Tedavisinde Ilaç Salınımlı Stent Uygulaması ve Etkinliği

Öz

Amaç: Ekstrakraniyal vertebral arter aterosklerotik hastalığı sinsi ve tehlikeli bir hastalıktır. Gelişen teknoloji ve artan tecrübelerle birlikte antiproliferatif ilaç salınımlı stentler vertebral arter orjininde stent içi stenozu azaltmaya alternatif oluşturmaktadır. Biz de çalışmamızda vertebral ostial stenozlarda ilaç salınımlı stent uygulamasının teknik başarısını, etkinliğini, klinik ve anjiyografik sonuçlarını değerlendirdik. Hastalar ve Yöntemler: Vertebral arter orijin darlığı olan 24 hastaya toplam 28 adet stent yerleştirildi. 6, 12, 24. aylarda anjiyografi veya BT anjiyografi ile takip edildi. Bulgular: Vertebral arter orijin darlıklarının tedavisinde paclitaxel salınımlı stent yüksek teknik başarı ile uygulandı. İşleme bağlı mortalite izlenmedi. Baziler arter inmesi nedeniyle başarılı stentleme ve tromboliz uygulanmış bir olgu aspirasyon pnömonisi nedeniyle kaybedildi. İşleme bağlı bir hastada (%4.1) subklavyen arterde sınırlı diseksiyon gelişti ve medikal tedavi ile takip edildi. Takipte bir adet stentte (%3.7) erken dönem (6.ay kontrol) stent içi restenoz gelişti, bir hastada (%4.1) rekürren nörolojik semptom izlendi (9.ay). Hastaların hiçbirinde geç dönem tromboz izlenmedi. Sonuç: Vertebral arter ostial stenozlarında ilaç salınımlı stentler yüksek teknik başarı ve düşük stent içi restenoz oranları ile etkin ve güvenle kullanılabilir. Düşük restenoz oranları ile de antiproliferatif ilaç salınımlı stentler VA orjininde stent içi stenozu azaltmaya alternatif oluşturmaktadır.

Anahtar Kelimeler

The Usage and Efficiency of Drug Eluting Stents in Vertebral Ostial Stenosis

Abstract

Objectives: Extracranial vertebral artery atherosclerosis is an insidious and hazardous disease. With technological development and accumulating experience, antiproliferative drug eluting stents became a viable option for reducing the instent restenosis of the origin of the vertebral artery. Here, we evaluated the technical success rates, efficiency, clinical and angiographic results of the usage of drug eluting stents in vertebral ostial stenosis. Patients and Methods: 28 stents were implanted in 24 patients with vertebral artery origin stenosis. Digital substraction angiographic or CT angiographic follow-up was made at 6, 12 and 24 months. Results: Paclitaxel eluting stents were placed with high technical success for the treatment of vertebral artery origin stenosis. There was no procedure related mortality. However one patient scummed to death due to aspiration pneumonia for a basiller artery stroke with successful stenting and thrombolysis procedure. There was only one limited subclavian artery dissection in a patient (%4.1) during the procedure which was managed conservatively. One stent (%3.7) had instent restenosis on early period (6th month) and one patient (%4.1) had recurrent neurological symptoms on follow-up (9th month). In a median follow-up of 13 months (6-25 months) none of the patients had late stent thrombosis. Conclusion: Vertebral artery ostial stenosis can be treated effectively and safely with high technical success and low instent restenosis rates with paclitaxel drug eluting stents. With low restenosis rates the antiproliferative drug eluting stents are an option for reducing the vertebral artery instent restenosis.

Keywords

References

1. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337(8756):1521-1526.
2. Phatouros CC, Higashida RT, Malek AM, Meyers PM, Lefler JE, Dowd CF, Halbach VV. Endovascular treatment of noncarotid extracranial cerebrovascular disease. Neurosurgery clinics of North America 2000;11(2):331-350.
3. Hass WK, Fields WS, North RR, Kircheff, II, Chase NE, Bauer RB. Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. Jama 1968;203(11):961-968.
4. Cloud GC, Markus HS. Diagnosis and management of vertebral artery stenosis. QJM : monthly journal of the Association of Physicians 2003;96(1):27-54.
5. Jenkins JS, White CJ, Ramee SR, Collins TJ, Chilakamarri VK, McKinley KL, Jain SP. Vertebral artery stenting. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2001;54(1):1-5.
6. Jenkins JS, White CJ, Ramee SR, Collins TJ, McKinley KL. Vertebral Insufficiency: When to Intervene and How? Current interventional cardiology reports 2000;2(2):91-94.
7. North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress. Stroke 1991;22(6):711-720.
8. Henry M, Henry I, Klonaris C, al. e. Angioplasty and stenting of the carotid and supra-aortic trunks: Percutaneous transluminal angioplasty and stenting of extracranial VA stenosis. 1st ed. London, UK: Taylor and Francis Medicine, 2003.

9. Berteloot D, Leclerc X, Leys D, Krivosic R, Pruvo JP. [Cerebral angiography: a study of complications in 450 consecutive procedures]. Journal de radiologie 1999;80(8):843-848.
10. Omori Y, Komatsu S, Murakawa T, Hirayama A, Sato Y, Fujisawa Y, Higashide T, Takahashi M, Kodama K. MDCT detection of left subclavian artery obstruction accompanied by anomalous origin of the left vertebral artery. International journal of cardiology 2007;115(2):244-245. doi: 10.1016/j.ijcard.2006.01.055
11. Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown MM. Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Stroke 2007;38(5):1526-1530. doi: 10.1161/STROKEAHA.106.471862
12. Compter A, van der Worp HB, Schonewille WJ, Vos JA, Boiten J, Nederkoorn PJ, Uyttenboogaart M, Lo RT, Algra A, Kappelle LJ. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. The Lancet Neurology 2015;14(6):606-614. doi: 10.1016/S1474-4422(15)00017-4
13. Markus HS, Larsson SC, Kuker W, Schulz UG, Ford I, Rothwell PM, Clifton A. Stenting for symptomatic vertebral artery stenosis: The Vertebral Artery Ischaemia Stenting Trial. Neurology 2017;89(12):1229-1236. doi: 10.1212/WNL.0000000000004385
14. Mukherjee D, Rosenfeld K. Manual of peripheral vascular intervention: Vertebral artery disease. Philadelphia, 2005.
15. Piotin M, Spelle L, Martin JB, Weill A, Rancurel G, Ross IB, Rufenacht DA, Chiras J. Percutaneous transluminal angioplasty and stenting of the proximal vertebral artery for symptomatic stenosis. AJNR American journal of neuroradiology 2000;21(4):727-731.
16. Wehman JC, Hanel RA, Guidot CA, Guterman LR, Hopkins LN. Atherosclerotic occlusive extracranial vertebral artery disease: indications for intervention, endovascular techniques, short-term and long-term results. Journal of interventional cardiology 2004;17(4):219-232. doi: 10.1111/j.1540-8183.2004.04055.x
17. Lin YH, Juang JM, Jeng JS, Yip PK, Kao HL. Symptomatic ostial vertebral artery stenosis treated with tubular coronary stents: clinical results and restenosis analysis. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2004;11(6):719-726. doi: 10.1583/04-1336.1
18. Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results. Stroke 2004;35(6):1388-1392. doi: 10.1161/01.STR.0000128708.86762.d6
19. Lin YH, Liu YC, Tseng WY, Juang JM, Hung CS, Lin JW, Jeng JS, Yip PK, Kao HL. The impact of lesion length on angiographic restenosis after vertebral artery origin stenting. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2006;32(4):379-385. doi: 10.1016/j.ejvs.2006.02.016
20. Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, Colombo A, Schuler G, Barragan P, Guagliumi G, Molnar F, Falotico R. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. The New England journal of medicine 2002;346(23):1773-1780. doi: 10.1056/NEJMoa012843
21. Axel DI, Kunert W, Goggelmann C, Oberhoff M, Herdeg C, Kuttner A, Wild DH, Brehm BR, Riessen R, Koveker G, Karsch KR. Paclitaxel inhibits arterial smooth muscle cell proliferation and migration in vitro and in vivo using local drug delivery. Circulation 1997;96(2):636-645.
22. Raghuram K, Seynnaeve C, Rai AT. Endovascular treatment of extracranial atherosclerotic disease involving the vertebral artery origins: a comparison of drug-eluting and bare-metal stents. Journal of neurointerventional surgery 2012;4(3):206-210. doi: 10.1136/neurintsurg-2011-010051
23. Tank VH, Ghosh R, Gupta V, Sheth N, Gordon S, He W, Modica SF, Prestigiacomo CJ, Gandhi CD. Drug eluting stents versus bare metal stents for the treatment of extracranial vertebral artery disease: a meta-analysis. Journal of neurointerventional surgery 2016;8(8):770-774. doi: 10.1136/neurintsurg-2015-011697
24. Langwieser N, Buyer D, Schuster T, Haller B, Laugwitz KL, Ibrahim T. Bare metal vs. drug-eluting stents for extracranial vertebral artery disease: a meta-analysis of nonrandomized comparative studies. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2014;21(5):683-692. doi: 10.1583/14-4713MR.1
25. Musialek P, Langwieser N. Commentary: vertebral artery ostial stenosis stenting technique: the concept reversed? Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2015;22(3):445-448. doi: 10.1177/1526602815583490
26. . http://spo.escardio.org/eslides/view.aspx?eevtid=54&fp=3170.
27. Li J, Hua Y, Needleman L, Forsberg F, Eisenbray JR, Li Z, Liu R, Tian X, Jiao L, Liu JB. Arterial occlusions increase the risk of in-stent restenosis after vertebral artery ostium stenting. Journal of neurointerventional surgery 2018. doi: 10.1136/neurintsurg-2018-014243
28. Geng X, Hussain M, Du H, Zhao L, Chen J, Su W, Ma L, Gao Z, Ding Y, Ji X. Comparison of self-expanding stents with distal embolic protection to balloon-expandable stents without a protection device in the treatment of symptomatic vertebral artery origin stenosis: a prospective randomized trial. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2015;22(3):436-444. doi: 10.1177/1526602815579406
29. Chung SY, Lee DH, Choi JW, Choi BS, In HS, Kim SM, Choi CG, Kim SJ, Suh DC. Use of self-expanding stents for the treatment of vertebral artery ostial stenosis: a single center experience. Korean journal of radiology 2010;11(2):156-163. doi: 10.3348/kjr.2010.11.2.156

Details

Primary Language

English

Subjects

Radiology and Organ Imaging

Journal Section

Research Article

Authors

Burcu Erkan ^*
Türkiye

Serdar Geyik
Türkiye

Kıvılcım Yavuz
Türkiye

Işıl Saatçi
Türkiye

Saruhan Çekirge
Türkiye

Publication Date

July 1, 2021

Submission Date

September 9, 2019

Acceptance Date

-

Published in Issue

Year 2021 Volume: 12 Number: 3

DOI

https://doi.org/10.31067/acusaglik.850835

IZ

https://izlik.org/JA56AN39LF

Cite

RIS / Bibtex

EndNote

Erkan B, Geyik S, Yavuz K, Saatçi I, Çekirge S (July 1, 2021) The Usage and Efficiency of Drug Eluting Stents in Vertebral Ostial Stenosis. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 12 3 564–573.