VERTEBRAL ARTERY STENTING FOLLOWING PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY - TECHNICAL NOTE

The authors report initial results and follow up using stent placement to treat atherosclerotic stenosis in vertebral arteries. Three patien ts with severe atherosclerotic vascular disease underwent vertebral ar tery stent placement using a balloon expandable stent. Medical therapy (aspirin and warfarin) and conventional percutaneous angioplasty fail ed to resolve the disease and the patients developed symptomatic reste nosis within 3 months of angioplasty. Two patients had symptoms of ant erior circulation ischemia with carotid artery occlusions and reduced supply to the anterior circulation from the stenosed vertebral arterie s. One patient had recurrent posterior circulation symptoms. Stents we re successfully placed in all three, resulting in immediate reversal o f stenosis and resolution of symptoms. Clinical followup study (mean 9 months) has shown no recurrent symptoms in the patient with posterior circulation symptoms, but the two patients with anterior circulation ischemia did develop recurrent symptoms. Angiographic follow up in the se two patients at 3 months and 1 year, however, demonstrated continue d patency of vertebral artery lumina. They under went extracranial-int racranial bypass surgery to relieve their symptoms. This experience su ggests stents can be placed without complication in the proximal verte bral arteries and may have an adjunctive role in the treatment of athe rosclerotic cerebrovascular disease following unsuccessful angioplasty .