AYŞENUR ÖNALAN, ERDEM GÜRKAŞ
Southern Clinics of Istanbul Eurasia - 2023;34(4):301-305
INTRODUCTION: The purpose of this study was to showcase the outcomes of endovascular treatment, assessing its safety and efficacy for patients with symptomatic severe atherosclerotic stenosis of the vertebral artery, who did not respond to medical management and were treated at our institution. METHODS: We performed a retrospective analysis on patients who had suffered a transient ischemic attack or ischemic stroke and received endovascular treatment for symptomatic vertebral stenosis despite being under medical care. The endovascular techniques utilized were cataloged as angioplasty alone, balloon-mounted stenting, or angioplasty with subsequent self-expanding stent insertion. We recorded both peri-procedural complications, such as in-stent thrombosis, dissection, and guide wire perforation, as well as post-procedural complications, including stroke and transient ischemic attack. The study focused on analyzing the endovascular treatment methodologies alongside clinical and radiological outcomes. Results: From January 2020 to December 2022, 15 patients were treated, including 6 with V1 segment stenosis, 2 with V2, and 7 with V4 segment stenosis. The rate of successful stent placement was 100% (15 out of 15). Six patients (40%) received a balloon-expandable stent in addition to angioplasty, while the remaining nine (60%) were treated with a self-expanding stent following angioplasty. No peri-procedural complications were reported in patients who had extracranial stenting. However, during intracranial stenting, complications occurred in two cases: one patient had a dissection leading to occlusion of a perforator artery, and another experienced stent thrombosis. These complications resulted in ischemic strokes and subsequent mortality during hospitalization in two patients (13% of the cohort). The median follow-up duration was 15 months, with an interquartile range of 9 to 24 months. An improvement in the modified Rankin Score was noted in 10 patients, while no change was observed in 3 patients. DISCUSSION AND CONCLUSION: Our findings advocate for the safety and probable efficacy of endovascular treatment in patients with vertebral artery stenosis who are non-responsive to optimal medical therapies. Stenting, particularly for extracranial vertebral artery stenosis, can be performed with a low rate of complications and is deemed safe.
