Treatment of Vertebral Artery Origin Stenosis with Anti-Proliferative Drug-Eluting Stents

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2008.00330.x Byline: Randall C. Edgell (1), Dileep R. Yavagal (1), Doniel Drazin (1), Raul Olivera (1), Alan S. Boulos (1) Keywords: Vertebral artery origin; stenosis; drug-eluting; stent; stroke Abstract: ABSTRACT BACKGROUND Vertebral artery origin stenosis is a known cause of stroke that is treatable with angioplasty and stenting. Previous studies have demonstrated that this technique is safe but is limited by high rates of in-stent stenosis. Anti-proliferative drug-eluting stents are an alternative for reducing in-stent stenosis at the vertebral artery origin. METHODS This retrospective study included five consecutive patients treated with anti-proliferative drug-eluting stents. The patients' demographics, indications for treatment, procedural technique, and clinical and radiographic follow-up are presented along with a review of the literature. RESULTS No peri-procedural complications occurred. One patient had a transient ischemic attack (TIA) during the follow-up period. No patients had hemodynamically significant (>50%) in-stent stenosis at follow-up. Among the 287 cases reported in the literature, there were two strokes (.7%), four TIAs (1.4%), and no procedurally related deaths. Among patients undergoing angiographic follow-up, 26% were found to have >50% in-stent stenosis. CONCLUSIONS Anti-proliferative drug-eluting stents hold promise for reducing in-stent stenosis at the vertebral artery origin. Author Affiliation: (1)From the Department of Surgery, Division of Neurosurgery, St. Louis University, St. Louis, MO (RCE, RO); Department of Neurology and Psychiatry, St. Louis University, St. Louis, MO (RCE); Department of Neurology, University of Miami, Miami, FL (DRY); Department of Surgery, Division of Neurosurgery, Albany Medical Center, Albany, NY (DD, ASB). Article History: Acceptance: Received September 2, 2008, and in revised from August 7, 2008. Accepted for publication September 24, 2008. Article note: Correspondence: Address correspondence to Randall C. Edgell, MD, Division of Neurosurgery, 3635 Vista Avenue at Grand, St. Louis, MO 63110. E-mail: randall.edgell@gmail.com