Study Supports Endovascular Vertebral Artery Stenting

February 9, 2010—In the Journal of the American College of Cardiology, Stephen Jenkins, MD, et al published findings from a study that sought to evaluate the safety and longterm durability of catheter-based therapy for symptomatic vertebral artery stenosis (VAS) (2010;55:538–542).

According to the investigators, symptomatic VAS carries with it a 5-year 30% to 35% risk of stroke. The 2-year mortality approaches 30% for medically managed strokes involving the posterior circulation. Surgical bypass is rarely performed because of high morbidity and mortality. Therefore, endovascular revascularization with primary stenting offers an attractive treatment option for these patients.

In the study, 105 consecutive symptomatic patients (112 arteries, 71% men) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995 to 2006. Fifty-seven patients (54%) had bilateral VAS, 71 patients (68%) had concomitant carotid disease, and 43 patients (41%) had a previous stroke.

As reported by the investigators, procedural and clinical success was achieved in 105 (100%) and 95 (90.5%) patients, respectively. One-year follow-up was obtained in 87 patients (82.9%), of which 69 patients (79.3%) remained symptomfree. At 1 year, six patients (5.7%) had died, and five patients (5%) had a posterior circulation stroke. Target vessel revascularization occurred in 7.4% at 1 year. At a median followup of 29.1 months (interquartile range 12.8–50.9 months), 13.1% underwent target vessel revascularization, 71.4% were alive, and 70.5% remained symptom-free.

The investigators concluded that in experienced hands, stenting for symptomatic VAS can be accomplished with a very high success rate (100%) with few periprocedural complications and is associated with durable symptom resolution in the majority (approximately 80%) of patients. Therefore, endovascular stenting of vertebral artery atherosclerotic disease is safe and effective compared with surgical controls and should be considered first-line therapy for this disease.