Clinical Neuroradiology

, Volume 29, Issue 4, pp 701–706 | Cite as

Long-Term Risk of In-Stent Restenosis and Stent Fracture for Extracranial Vertebral Artery Stenting

  • Man Kwun Andrew Li
  • Anderson Chun On TsangEmail author
  • Frederick Chun Pong Tsang
  • Wai Shing Ho
  • Raymand Lee
  • Gilberto Ka Kit Leung
  • Wai Man Lui
Original Article



Stenting and angioplasty of the vertebral artery (VA) is used to treat symptomatic stenosis but the long-term outcomes and complications are unclear. This study evaluated the long-term clinical outcomes and procedure-related complications in patients who underwent extracranial VA stenting and angioplasty, in particular the risks of in-stent restenosis (ISR) and stent fracture.


This was a retrospective review of consecutive patients suffering from symptomatic extracranial VA stenosis who were treated with balloon-expandable bare metal stents. The clinical and angiographical outcomes were reviewed for procedural complications, recurrent stroke, ISR and stent fracture.


In this study 22 patients (17 male, 5 female) with a mean age of 63.4 years (SD 9.1 years) were included. The median follow-up was 56 months (interquartile range IQR 51.8 months). There were no periprocedural complications. The cumulative ISR risk was 45% with 6 cases detected at 1 year and 3 cases detected at 3 years post operation. The cumulative stent fracture rate at 1 year, 3 years, 5 years and the entire follow-up period were 5%, 15%, 25%, and 30%, respectively. Posterior circulation stroke occurred in 1 patient (4.5%), and 3 patients died of non-cerebrovascular causes during follow-up. Of the patients 2 with ISR and stent fracture required additional treatment.


The long-term ISR and stent fracture risks were high in extracranial VA stenosis treated with balloon-expandable bare metal stents. The risk of stent fracture increased over time during the follow-up period. Further studies should be conducted to clarify the long-term safety and efficacy of extracranial VA stenting.


Angioplasty Vertebral artery stenting Stroke In-stent restenosis Stent fracture 



In-stent restenosis


Transient ischemic attack


Vertebral artery



The authors would like to thank Ms Sanna Wong for her valuable expertise in data collection and analysis.

Conflict of interest

M.K.A. Li, A.C. On Tsang, F.C. Pong Tsang, W.S. Ho, R. Lee, G.K. Kit Leung and W.M. Lui declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongHong Kong
  2. 2.Division of Neurosurgery, Department of Surgery, Queen Mary HospitalThe University of Hong KongHong KongHong Kong
  3. 3.Department of Diagnostic RadiologyQueen Mary HospitalHong KongHong Kong
  4. 4.Department of NeurosurgeryQueen Mary HospitalHong KongHong Kong

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