A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis

Felipe C. Albuquerque, David Fiorella, Patrick Han, Robert F. Spetzler, Cameron G. McDougall, Robert H. Rosenwasser, Sean Cullen, Perry P. Ng, Randall T. Higashida, Mark R. Harrigan, L. Nelson Hopkins, Gerald M Lemole, Bernd Richling, Michael P. Marks

Research output: Contribution to journalArticle

134 Citations (Scopus)

Abstract

OBJECTIVE: To assess the rate of restenosis after vertebral origin angioplasty and stenting (VOAS). METHODS: We reviewed the records of 33 patients (24 men, 9 women; age range, 49-81 yr; mean, 64.5 yr) who underwent VOAS during a period of 5 years and followed each for the development of adverse sequelae through a prospectively maintained database. A neuroradiologist not involved in the stenting procedures assessed original and follow-up angiograms for evidence of restenosis. Restenosis was quantified as insignificant (0-24%), mild (25-49%), moderate (50-74%), or severe (75-100%). RESULTS: Of the 33 patients, 30 presented with transient ischemic attacks or stroke. Most (31 of 33 patients) manifested other brachiocephalic stenoses, including 27 patients with occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Angiographic follow-up (mean, 16.2 mo) was obtained in 30 patients (2 patients died before follow-up, and 1 refused). Restenosis was mild in seven patients, moderate in eight, and severe in five. The combined rate of moderate-to-severe restenosis was 43.3%. No complications resulted in permanent morbidity. One patient died as a result of a stroke in a different vascular distribution 4 months after VOAS. Another patient died as a result of basilar thrombosis in which emergent stenting had been undertaken in an effort to perform thrombolysis. CONCLUSION: Despite a technical success rate of 97% and a low incidence of complications, VOAS is associated with a high rate of moderate-to-severe restenosis.

Original languageEnglish (US)
Pages (from-to)607-616
Number of pages10
JournalNeurosurgery
Volume53
Issue number3
StatePublished - Sep 1 2003
Externally publishedYes

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Angioplasty
Pathologic Constriction
Therapeutics
Stroke
Vertebrobasilar Insufficiency
Transient Ischemic Attack
Blood Vessels
Angiography
Thrombosis
Databases
Morbidity
Incidence

Keywords

  • Angioplasty
  • Stenting
  • Vertebral artery origin

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Albuquerque, F. C., Fiorella, D., Han, P., Spetzler, R. F., McDougall, C. G., Rosenwasser, R. H., ... Marks, M. P. (2003). A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery, 53(3), 607-616.

A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. / Albuquerque, Felipe C.; Fiorella, David; Han, Patrick; Spetzler, Robert F.; McDougall, Cameron G.; Rosenwasser, Robert H.; Cullen, Sean; Ng, Perry P.; Higashida, Randall T.; Harrigan, Mark R.; Hopkins, L. Nelson; Lemole, Gerald M; Richling, Bernd; Marks, Michael P.

In: Neurosurgery, Vol. 53, No. 3, 01.09.2003, p. 607-616.

Research output: Contribution to journalArticle

Albuquerque, FC, Fiorella, D, Han, P, Spetzler, RF, McDougall, CG, Rosenwasser, RH, Cullen, S, Ng, PP, Higashida, RT, Harrigan, MR, Hopkins, LN, Lemole, GM, Richling, B & Marks, MP 2003, 'A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis', Neurosurgery, vol. 53, no. 3, pp. 607-616.
Albuquerque FC, Fiorella D, Han P, Spetzler RF, McDougall CG, Rosenwasser RH et al. A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery. 2003 Sep 1;53(3):607-616.
Albuquerque, Felipe C. ; Fiorella, David ; Han, Patrick ; Spetzler, Robert F. ; McDougall, Cameron G. ; Rosenwasser, Robert H. ; Cullen, Sean ; Ng, Perry P. ; Higashida, Randall T. ; Harrigan, Mark R. ; Hopkins, L. Nelson ; Lemole, Gerald M ; Richling, Bernd ; Marks, Michael P. / A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. In: Neurosurgery. 2003 ; Vol. 53, No. 3. pp. 607-616.
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abstract = "OBJECTIVE: To assess the rate of restenosis after vertebral origin angioplasty and stenting (VOAS). METHODS: We reviewed the records of 33 patients (24 men, 9 women; age range, 49-81 yr; mean, 64.5 yr) who underwent VOAS during a period of 5 years and followed each for the development of adverse sequelae through a prospectively maintained database. A neuroradiologist not involved in the stenting procedures assessed original and follow-up angiograms for evidence of restenosis. Restenosis was quantified as insignificant (0-24{\%}), mild (25-49{\%}), moderate (50-74{\%}), or severe (75-100{\%}). RESULTS: Of the 33 patients, 30 presented with transient ischemic attacks or stroke. Most (31 of 33 patients) manifested other brachiocephalic stenoses, including 27 patients with occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Angiographic follow-up (mean, 16.2 mo) was obtained in 30 patients (2 patients died before follow-up, and 1 refused). Restenosis was mild in seven patients, moderate in eight, and severe in five. The combined rate of moderate-to-severe restenosis was 43.3{\%}. No complications resulted in permanent morbidity. One patient died as a result of a stroke in a different vascular distribution 4 months after VOAS. Another patient died as a result of basilar thrombosis in which emergent stenting had been undertaken in an effort to perform thrombolysis. CONCLUSION: Despite a technical success rate of 97{\%} and a low incidence of complications, VOAS is associated with a high rate of moderate-to-severe restenosis.",
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T1 - A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis

AU - Albuquerque, Felipe C.

AU - Fiorella, David

AU - Han, Patrick

AU - Spetzler, Robert F.

AU - McDougall, Cameron G.

AU - Rosenwasser, Robert H.

AU - Cullen, Sean

AU - Ng, Perry P.

AU - Higashida, Randall T.

AU - Harrigan, Mark R.

AU - Hopkins, L. Nelson

AU - Lemole, Gerald M

AU - Richling, Bernd

AU - Marks, Michael P.

PY - 2003/9/1

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N2 - OBJECTIVE: To assess the rate of restenosis after vertebral origin angioplasty and stenting (VOAS). METHODS: We reviewed the records of 33 patients (24 men, 9 women; age range, 49-81 yr; mean, 64.5 yr) who underwent VOAS during a period of 5 years and followed each for the development of adverse sequelae through a prospectively maintained database. A neuroradiologist not involved in the stenting procedures assessed original and follow-up angiograms for evidence of restenosis. Restenosis was quantified as insignificant (0-24%), mild (25-49%), moderate (50-74%), or severe (75-100%). RESULTS: Of the 33 patients, 30 presented with transient ischemic attacks or stroke. Most (31 of 33 patients) manifested other brachiocephalic stenoses, including 27 patients with occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Angiographic follow-up (mean, 16.2 mo) was obtained in 30 patients (2 patients died before follow-up, and 1 refused). Restenosis was mild in seven patients, moderate in eight, and severe in five. The combined rate of moderate-to-severe restenosis was 43.3%. No complications resulted in permanent morbidity. One patient died as a result of a stroke in a different vascular distribution 4 months after VOAS. Another patient died as a result of basilar thrombosis in which emergent stenting had been undertaken in an effort to perform thrombolysis. CONCLUSION: Despite a technical success rate of 97% and a low incidence of complications, VOAS is associated with a high rate of moderate-to-severe restenosis.

AB - OBJECTIVE: To assess the rate of restenosis after vertebral origin angioplasty and stenting (VOAS). METHODS: We reviewed the records of 33 patients (24 men, 9 women; age range, 49-81 yr; mean, 64.5 yr) who underwent VOAS during a period of 5 years and followed each for the development of adverse sequelae through a prospectively maintained database. A neuroradiologist not involved in the stenting procedures assessed original and follow-up angiograms for evidence of restenosis. Restenosis was quantified as insignificant (0-24%), mild (25-49%), moderate (50-74%), or severe (75-100%). RESULTS: Of the 33 patients, 30 presented with transient ischemic attacks or stroke. Most (31 of 33 patients) manifested other brachiocephalic stenoses, including 27 patients with occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Angiographic follow-up (mean, 16.2 mo) was obtained in 30 patients (2 patients died before follow-up, and 1 refused). Restenosis was mild in seven patients, moderate in eight, and severe in five. The combined rate of moderate-to-severe restenosis was 43.3%. No complications resulted in permanent morbidity. One patient died as a result of a stroke in a different vascular distribution 4 months after VOAS. Another patient died as a result of basilar thrombosis in which emergent stenting had been undertaken in an effort to perform thrombolysis. CONCLUSION: Despite a technical success rate of 97% and a low incidence of complications, VOAS is associated with a high rate of moderate-to-severe restenosis.

KW - Angioplasty

KW - Stenting

KW - Vertebral artery origin

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