CardioVascular and Interventional Radiology

, Volume 34, Issue 3, pp 481–487 | Cite as

Influence of Vessel Size and Tortuosity on In-stent Restenosis After Stent Implantation in the Vertebral Artery Ostium

  • Zhiming Zhou
  • Qin Yin
  • Gelin Xu
  • Xuanye Yue
  • Renliang Zhang
  • Wusheng Zhu
  • Xiaobing Fan
  • Minmin Ma
  • Xinfeng Liu
Clinical Investigation
First Online:
Received:
Accepted:

Abstract

Purpose

Percutaneous transluminal angioplasty and stenting is emerging as an alternative for treating atherosclerotic stenosis in the vertebral artery ostium. However, in-stent restenosis (ISR) still remains a critical issue to be addressed. Little is known about the relationship between anatomic characteristics of the artery and ISR after stent implantation. In this study, we have evaluated influential factors for ISR in a cohort of the patients with stenting in the vertebral artery ostium.

Methods

Sixty-one patients with 63 symptomatic lesions in vertebral artery ostium treated with stenting were enrolled onto this study. An average of 12.5 months’ clinical and angiographic follow-up results were analyzed retrospectively. The possible influential factors for ISR, including conventional risk factors of cerebrovascular diseases and morphological characteristics of target lesions, were evaluated by univariate and multivariate regression analysis.

Results

Technical success was achieved in all 63 interventional procedures. Stenosis was reduced from (mean ± standard deviation) 75.5 ± 12% before to 1 ± 3.6% after the procedure. During the mean 12.5-month angiographic follow-up, ISR was detected in 17 treated vessels (27.0%), with 2 treated arteries (3.2%) resulting in occlusion, and a stent fracture in 1 case (1.6%). Multivariate Cox regression analysis showed that the tortuosity of V1 (hazard ratio 3.54, P = 0.01) and smaller diameter of the stent (hazard ratio 3.8, P = 0.04) were independent predictors of ISR.

Conclusions

Angioplasty and stenting for symptomatic stenosis in the vertebral artery ostium stenosis seem to be feasible and effective. Tortuosity and smaller diameter may affect ISR after stent implantation.

Keywords

Atherosclerotic stenosis Restenosis Stent Stroke Tortuosity Vertebral artery 
This is a preview of subscription content, log in to check access.

Notes

Conflict of interest

None.

References

  1. 1.
    Caplan LR, Wityk RJ, Glass TA et al (2004) New England Medical Center Posterior Circulation Registry. Ann Neurol 56:389–398PubMedCrossRefGoogle Scholar
  2. 2.
    Wityk RJ, Chang HM, Rosengart A et al (1998) Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 55:470–478PubMedCrossRefGoogle Scholar
  3. 3.
    Savitz SI, Caplan LR (2005) Vertebrobasilar disease. N Engl J Med 352:2618–2626PubMedCrossRefGoogle Scholar
  4. 4.
    Algra A, van Gijn J (1999) Cumulative meta-analysis of aspirin efficacy after cerebral ischaemia of arterial origin. J Neurol Neurosurg Psychiatry 66:255PubMedCrossRefGoogle Scholar
  5. 5.
    Cloud GC, Markus HS (2003) Diagnosis and management of vertebral artery stenosis. QJM 96:27–54PubMedCrossRefGoogle Scholar
  6. 6.
    Deriu GP, Ballotta E, Franceschi L et al (1991) Surgical management of extracranial vertebral artery occlusive disease. J Cardiovasc Surg (Torino) 32:413–419Google Scholar
  7. 7.
    Imparato AM (1985) Vertebral arterial reconstruction: a nineteen-year experience. J Vasc Surg 2:626–634PubMedCrossRefGoogle Scholar
  8. 8.
    Akins PT, Kerber CW, Pakbaz RS (2008) Stenting of vertebral artery origin atherosclerosis in high-risk patients: bare or coated? A single-center consecutive case series. J Invasive Cardiol 20:14–20PubMedGoogle Scholar
  9. 9.
    Dabus G, Gerstle RJ, Derdeyn CP et al (2006) Endovascular treatment of the vertebral artery origin in patients with symptoms of vertebrobasilar ischemia. Neuroradiology 48:917–923PubMedCrossRefGoogle Scholar
  10. 10.
    Hatano T, Tsukahara T, Ogino E et al (2005) Stenting for vertebrobasilar artery stenosis. Acta Neurochir Suppl 94:137–141PubMedCrossRefGoogle Scholar
  11. 11.
    Lin YH, Hung CS, Tseng WY et al (2008) Safety and feasibility of drug-eluting stent implantation at vertebral artery origin: the first case series in Asians. J Formos Med Assoc 107:253–258PubMedCrossRefGoogle Scholar
  12. 12.
    Albuquerque FC, Fiorella D, Han P et al (2003) A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery 53:607–614PubMedCrossRefGoogle Scholar
  13. 13.
    Lin YH, Liu YC, Tseng WY et al (2006) The impact of lesion length on angiographic restenosis after vertebral artery origin stenting. Eur J Vasc Endovasc Surg 32:379–385PubMedCrossRefGoogle Scholar
  14. 14.
    Taylor RA, Siddiq F, Suri MF et al (2008) Risk factors for in-stent restenosis after vertebral ostium stenting. J Endovasc Ther 15:203–212PubMedCrossRefGoogle Scholar
  15. 15.
    Groschel K, Riecker A, Schulz JB et al (2005) Systematic review of early recurrent stenosis after carotid angioplasty and stenting. Stroke 36:367–373PubMedCrossRefGoogle Scholar
  16. 16.
    Zhou W, Lin PH, Bush RL et al (2006) Management of in-sent restenosis after carotid artery stenting in high-risk patients. J Vasc Surg 43:305–312PubMedCrossRefGoogle Scholar
  17. 17.
    Matula C, Trattnig S, Tschabitscher M et al (1997) The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol 48:125–131PubMedCrossRefGoogle Scholar
  18. 18.
    North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453CrossRefGoogle Scholar
  19. 19.
    Togni M, Eber S, Widmer J et al (2007) Impact of vessel size on outcome after implantation of sirolimus-eluting and paclitaxel-eluting stents: a subgroup analysis of the SIRTAX trial. J Am Coll Cardiol 50:1123–1131PubMedCrossRefGoogle Scholar
  20. 20.
    Liu X, Xu G, Wu W, et al. (2006) Subtypes and one-year survival of first-ever stroke in Chinese patients: the Nanjing Stroke Registry. Cerebrovasc Dis 22:130–136Google Scholar
  21. 21.
    Henry M, Polydorou A, Henry I et al (2005) Angioplasty and stenting of extracranial vertebral artery stenosis. Int Angiol 24:311–324PubMedGoogle Scholar
  22. 22.
    Wehman JC, Hanel RA, Guidot CA et al (2004) Atherosclerotic occlusive extracranial vertebral artery disease: indications for intervention, endovascular techniques, short-term and long-term results. J Interv Cardiol 17:219–232PubMedCrossRefGoogle Scholar
  23. 23.
    Voetsch B, DeWitt LD, Pessin MS, Caplan LR (2004) Basilar artery occlusive disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 61:496–504PubMedCrossRefGoogle Scholar
  24. 24.
    Ausman JI, Diaz FG, Pearce JE et al (1982) Endarterectomy of the vertebral artery from C2 to posterior inferior cerebellar artery intracranially. Surg Neurol 18:400–404PubMedCrossRefGoogle Scholar
  25. 25.
    Chastain HD II, Campbell MS, Iyer S et al (1999) Extracranial vertebral artery stent placement: in-hospital and follow-up results. J Neurosurg 91:547–552PubMedCrossRefGoogle Scholar
  26. 26.
    Tsutsumi M, Kazekawa K, Onizuka M et al (2007) Stent fracture in revascularization for symptomatic ostial vertebral artery stenosis. Neuroradiology 49:253–257PubMedCrossRefGoogle Scholar
  27. 27.
    Investigators SS (2004) Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA): study results. Stroke 35:1388–1392CrossRefGoogle Scholar
  28. 28.
    Elezi S, Dibra A, Mehilli J et al (2006) Vessel size and outcome after coronary drug-eluting stent placement: results from a large cohort of patients treated with sirolimus- or paclitaxel-eluting stents. J Am Coll Cardiol 48:1304–1309PubMedCrossRefGoogle Scholar
  29. 29.
    Kornowski R, Fort S, Almagor Y et al (2008) Impact of vessel size, lesion length and diabetes mellitus on angiographic restenosis outcomes: insights from the NIRTOP study. Acute Card Care 10:104–110PubMedCrossRefGoogle Scholar
  30. 30.
    Sommer CM, Grenacher L, Stampfl U et al (2010) Impact of stent design on in-stent stenosis in a rabbit iliac artery model. Cardiovasc Intervent Radiol 33:565–575PubMedCrossRefGoogle Scholar
  31. 31.
    Vajda Z, Miloslavski E, Guthe T et al (2009) Treatment of stenoses of vertebral artery origin using short drug-eluting coronary stents: improved follow-up results. AJNR Am J Neuroradiol 30:1653–1656PubMedCrossRefGoogle Scholar
  32. 32.
    Yu SC, Leung TW, Lam JS et al (2009) Symptomatic ostial vertebral artery stenosis: treatment with drug-eluting stents—clinical and angiographic results at 1-year follow-up. Radiology 251:224–232PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Zhiming Zhou
    • 1
    • 2
  • Qin Yin
    • 1
  • Gelin Xu
    • 1
  • Xuanye Yue
    • 1
    • 3
  • Renliang Zhang
    • 1
  • Wusheng Zhu
    • 1
  • Xiaobing Fan
    • 1
  • Minmin Ma
    • 1
  • Xinfeng Liu
    • 1
  1. 1.Department of NeurologyJinling Hospital, Nanjing University School of MedicineNanjingChina
  2. 2.Department of NeurologyYijishan Hospital, Wannan Medical CollegeWuhuChina
  3. 3.Department of NeurologyShiyan People’s Hospital, Yunyang Medical CollegeShiyanChina

Personalised recommendations