Percutaneous transluminal angioplasty and stenting of the proximal vertebral artery for symptomatic stenosis

BACKGROUND AND PURPOSE: Percutaneous transluminal angioplasty (PTA) for sig nificant stenosis involving the origin of the vertebral artery is now a wel l established treatment for selected patients when posterior cerebral arter ial circulation is compromised, Arterial spasm, dissection, and restenosis may occur in some instances, with subsequent hemodynamic compromise. To pre vent these potential complications, we combined PTA of the vertebral artery with primary stenting, using coronary stents, in seven patients. We herein present our short- and intermediate-term results, METHODS: A total of seven lesions affecting the origin of the vertebral art ery were treated by primary trans-stenotic coronary stent placement, All pa tients were symptomatic, fulfilling the general criteria for vertebral arte ry angioplasty, Patients were followed for up to 36 months after treatment, RESULTS: All seven lesions were successfully dilated, Residual stenosis was never greater than 20% in diameter, No perioperative complications occurre d. Clinical follow-up showed immediate resolution or improvement of symptom s in all patients, One patient's condition deteriorated 15 months after ste nt placement because of atheromatous stenosis of the prevertebral segment i n the ipsilateral subclavian artery, CONCLUSION: Stent placement to treat significant stenosis involving the ori gin of the vertebral artery is safe and effective for alleviating symptoms and improving blood flow to the posterior cerebral circulation. Coronary st ent design seems to be particularly well suited to cover atherosclerotic le sions of the origin of the vertebral artery, The stent mesh probably preven ts elastic recoil and early restenosis after PTA, as it does in coronary ar teries.