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Objective: To evaluate the relationship between vertebrobasilar ischemia (VBI) and sleep apnea hypopnea syndrome (SAHS) and the effect of percutaneous transluminal stenting for VBI on the clinical parameters of SAHS., Methods: Twenty patients with VBI were included for clinical history, physical examination with sleep quentionnaires and scored by the Epworth Sleepiness Scale (ESS). Polysomnographic (PSG) studies were performed before and after vascular stenting for VBI. The relationship among clinical factors, the incidence and characteristics of SAHS were analyzed. The changes of apnea hypopnea index (AHI), longest apnea duration (LAD), the total time of apnea and hypopnea (AH%), the lowest arterial saturation (LSaO(2)) and oxygen desaturation index (ODI(4)) before and after vascular stenting were compared., Results: PSG studies were performed in 20 cases of VBI. SAHS was confirmed in 17 of the 20 patients, including mild (10/20), moderate (3/20) and severe (4/20), all were of obstructive. Before stenting therapy, AHI was 11.3/h (6.3 - 23.6)/h, but was 5.0/h (1.6 - 12.7)/h after therapy. LAD was (31.5 +/- 18.6) s vs (19.5 +/- 12.4) s, LSaO2 was (83.6 +/- 7.1)% vs (86.1 +/- 3.3)%, the AH% was [2.3 (0.6% - 9.8)%] vs [6.9% (2.6 - 14.3)%], ODI(4) was 10.1/h (5.3 - 29.0)/h vs 5.8/h (2.7 - 17.0)/h, respectively before and after stenting. AHI, LAD and ODI(4) were significantly decreased and LSaO(2) was increased after stenting for VBI., Conclusion: This series of patients with cerebravascular ischemia caused by vertebrobasilar artery stenosis had a high prevalence of obstructive sleep apnea. Vertebrobasilar vascular stenting was shown to be a reliable method of decreasing the degree of sleep-disordered breathing and hypoxia for SAHS patients with vertebrobasilar artery stenosis.

Purpose: To retrospectively evaluate the cerebrovascular complications from elective stent placement for symptomatic intracranial stenosis and to explore preliminarily which factors are associated with complications., Materials and Methods: Institutional ethics committee approval was obtained, with waiver of informed consent. Records were reviewed of 181 consecutive elective stent placement procedures in 169 patients (mean age, 51.8 years; 142 male and 27 female patients) with symptomatic intracranial stenosis of more than 50% diameter reduction. Complications were evaluated. Fisher exact or chi(2) tests were used to assess statistical differences between rates for discrete variables. Stratification analysis was used to assess the significant relationship (P < .05) between a potential risk factor and a complication., Results: Complications occurred in 20 patients (11.8%) of 169 patients: Ten patients (5.9%) had stroke (four patients had symptomatic intracranial hemorrhages [ICHs], and two of these patients died; six patients had ischemic strokes). Six patients had target-lesion thrombosis for which intrathrombus thrombolysis resulted in early complete patency without sequelae, two had asymptomatic ICHs, one had transient ischemic attack, and one had asymptomatic dissection. Perioperative noncompliance with antiplatelet therapy was found to be significantly associated with target-lesion thrombosis (two of eight patients [noncompliance] vs four of 161 patients [compliance], P = .027). Stratification analysis revealed a significant correlation between the use of double stents for a lesion and ICH (P = .005)., Conclusion: Cerebrovascular complications from elective stent placement for intracranial stenosis are diverse. The use of double stents for a lesion is an independent risk factor for ICH. Perioperative noncompliance with antiplatelet therapy is associated with a higher frequency of target-lesion thrombosis.

Objective: To evaluate the safety, feasibility and long-term results of stent-assisted angioplasty in atherosclerotic ostial stenosis of vertebral artery (VA)., Methods: Forty one patients (48 lesions) with symptomatic cerebral ischemic events or stroke attributed to VA atherosclerotic ostial stenosis > or = 50% (NASCET method) found in digital subtraction angiography (DSA) were approached for consent to participate in the study. During the procedure, three cases used protection devices and three used drug-eluting stents., Results: Thirty seven of the patients were male and 4 female. Mean age was 63.4 years (range 36 - 80). Technical success was achieved in 97.9 % of the lesions. One suffered from a stroke that occurred within 30-days postprocedural. 37 patients were followed up for 22.4 months. The clinical follow-up outcomes showed that there were no lesion-related strokes and deaths, three appeared to have return of neurological symptoms (TIA). Among the 21 patients (26 lesions) who had angiography follow-up, re-stenosis (> or = 50%) was revealed in 9 patients (9 lesions) (34.6%). However, seven of these 9 patients remained asymptomatic., Conclusions: Stent-assisted angioplasty for atherosclerotic ostial stenosis of VA is safe and feasible. It can prevent the lesion-related stroke, death and TIA recurrence. However, further studies are needed to clarify how to reduce the relatively high re-stenosis rate.