Medknow Publications on behalf of the Neurological Society of India
Abstract
Background : Vertebral artery ostial stenosis (VAOS) is one of the most
frequent causes of posterior circulation stroke. Percutaneous
angioplasty and stenting (PTAS) is one of the treatment modalities.
Patients and Methods : This is a longitudinal observational study from
September 2006 to February 2009, conducted at hospitals affiliated with
the Shiraz University of Medical Sciences, Shiraz, southern Iran. The
patient cohort included patients with posterior circulation stroke or
transient ischemic attack (TIA) and more than 70% VAOS, and patients
with asymptomatic VAOS of more than 70% and aplasia or total occlusion
of the contralateral VA or subclavian artery. All the patients
underwent PTAS with balloon-mounted bare coronary stents. Technical
success, procedural complications, composite outcomes of death, stroke
or TIA in the vertebrobasilar territory during the first 30 days,
stroke or TIA in the vertebrobasilar territory, and restenosis during
follow-up, were assessed. Results : During the study period, 81
patients (mean age 68 + 8.9 years, 63 (78%) males, 71 symptomatic and
18 asymptomatic) underwent the procedure. Technical success was
achieved in 88 (99%) patients. Procedure-related complications, other
than puncture site complications, were seen in two patients (2.2%). The
composite outcome of death, stroke or TIA in the vertebrobasilar
territory during the first 30 days was 1%. None of the patients had
clinical recurrence or restenosis during the follow-up (mean follow-up
14 months). Conclusion : Percutaneous transluminal angioplasty and
stenting of the proximal VA was feasible and safe. The risk of
restenosis should be analyzed in long-term studies with angiographic
follow-up