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Transradial approach for vertebral artery stenting.

Maciejewski D, Tekieli Ł, Kabłak-Ziembicka A, Paluszek P, Trystuła M, Wójcik-Pędziwiatr M, Machnik R, Pieniążek P - Postepy Kardiol Interwencyjnej (2015)

Bottom Line: The technical success rate was 100%.One patient died 20 months after intervention from unknown causes.Transradial VA stenting may be a very effective and safe procedure, and it may constitute an alternative to the femoral approach in patients with symptomatic VA stenosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Cardiology, Institute of Cardiology, Medical College, Jagiellonian University, John Paul II Hospital, Krakow, Poland.

ABSTRACT

Introductuion: Symptomatic severe vertebral artery (VA) stenosis may be treated safely with stent supported angioplasty via femoral access. There is limited clinical data on transradial approach for VA angioplasty in case of peripheral artery disease.

Aim: To evaluate the safety and efficacy of transradial angioplasty of symptomatic VA stenosis.

Material and methods: Fifteen patients (age 66 ±7.4 years, 73% men, with VA > 80% stenosis, 11 right-side, all symptomatic from posterior circulation (history of stroke, TIA, or chronic ischaemia symptoms)) with peripheral artery disease (PAD) or unsuccessful attempt via femoral approach were scheduled for VA angioplasty by radial access. Clinical and duplex ultrasound (DUS) follow-up were performed before discharge and 1, 12, and 24 months after VA angioplasty.

Results: The technical success rate was 100%. In all cases VA angioplasty was performed with the use of single balloon-mounted stent (9 bare metal stents, 6 drug-eluting stents). The mean NASCET VA stenosis was reduced from 85.3% to 5.3% (p < 0.001). No periprocedural death, stroke, myocardial infarction, or transient ischaemic attack occurred. During 24-months follow-up, in 12 of 15 patients chronic ischaemia symptoms release was observed, and no new acute ischaemic neurological symptoms were diagnosed in all patients. One patient died 20 months after intervention from unknown causes. There was one symptomatic borderline VA in-stent stenosis 12 months after angioplasty.

Conclusions: Transradial VA stenting may be a very effective and safe procedure, and it may constitute an alternative to the femoral approach in patients with symptomatic VA stenosis.

No MeSH data available.


Related in: MedlinePlus

A – Left subclavian artery occlusion and right vertebral ostium stenosis (large arrow) diagnosed in CT angiography. B – Angiography confirming vertebral stenosis. C – Skylor 4.5 mm × 13 mm post-dilatation. D – Final angiography showing optimal effect of VASRVA – right vertebral artery, LVA – left vertebral artery, CCT – costocervical trunk, TCT – thyrocervical trunk.
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Figure 0001: A – Left subclavian artery occlusion and right vertebral ostium stenosis (large arrow) diagnosed in CT angiography. B – Angiography confirming vertebral stenosis. C – Skylor 4.5 mm × 13 mm post-dilatation. D – Final angiography showing optimal effect of VASRVA – right vertebral artery, LVA – left vertebral artery, CCT – costocervical trunk, TCT – thyrocervical trunk.

Mentions: Between Jan 2010 and Jul 2014, 15 patients with severe, symptomatic VA stenosis were included in study. Table I shows patient characteristics. All VA stenosis as well as aortic arch anatomy were demonstrated in computed tomographic angiography (Figure 1A). Transfemoral access was not feasible due to peripheral artery disease (PAD) in 8 (53%) patients and due to severe subclavian artery tortuosity in 7 (47%) patients.


Transradial approach for vertebral artery stenting.

Maciejewski D, Tekieli Ł, Kabłak-Ziembicka A, Paluszek P, Trystuła M, Wójcik-Pędziwiatr M, Machnik R, Pieniążek P - Postepy Kardiol Interwencyjnej (2015)

A – Left subclavian artery occlusion and right vertebral ostium stenosis (large arrow) diagnosed in CT angiography. B – Angiography confirming vertebral stenosis. C – Skylor 4.5 mm × 13 mm post-dilatation. D – Final angiography showing optimal effect of VASRVA – right vertebral artery, LVA – left vertebral artery, CCT – costocervical trunk, TCT – thyrocervical trunk.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372629&req=5

Figure 0001: A – Left subclavian artery occlusion and right vertebral ostium stenosis (large arrow) diagnosed in CT angiography. B – Angiography confirming vertebral stenosis. C – Skylor 4.5 mm × 13 mm post-dilatation. D – Final angiography showing optimal effect of VASRVA – right vertebral artery, LVA – left vertebral artery, CCT – costocervical trunk, TCT – thyrocervical trunk.
Mentions: Between Jan 2010 and Jul 2014, 15 patients with severe, symptomatic VA stenosis were included in study. Table I shows patient characteristics. All VA stenosis as well as aortic arch anatomy were demonstrated in computed tomographic angiography (Figure 1A). Transfemoral access was not feasible due to peripheral artery disease (PAD) in 8 (53%) patients and due to severe subclavian artery tortuosity in 7 (47%) patients.

Bottom Line: The technical success rate was 100%.One patient died 20 months after intervention from unknown causes.Transradial VA stenting may be a very effective and safe procedure, and it may constitute an alternative to the femoral approach in patients with symptomatic VA stenosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Cardiology, Institute of Cardiology, Medical College, Jagiellonian University, John Paul II Hospital, Krakow, Poland.

ABSTRACT

Introductuion: Symptomatic severe vertebral artery (VA) stenosis may be treated safely with stent supported angioplasty via femoral access. There is limited clinical data on transradial approach for VA angioplasty in case of peripheral artery disease.

Aim: To evaluate the safety and efficacy of transradial angioplasty of symptomatic VA stenosis.

Material and methods: Fifteen patients (age 66 ±7.4 years, 73% men, with VA > 80% stenosis, 11 right-side, all symptomatic from posterior circulation (history of stroke, TIA, or chronic ischaemia symptoms)) with peripheral artery disease (PAD) or unsuccessful attempt via femoral approach were scheduled for VA angioplasty by radial access. Clinical and duplex ultrasound (DUS) follow-up were performed before discharge and 1, 12, and 24 months after VA angioplasty.

Results: The technical success rate was 100%. In all cases VA angioplasty was performed with the use of single balloon-mounted stent (9 bare metal stents, 6 drug-eluting stents). The mean NASCET VA stenosis was reduced from 85.3% to 5.3% (p < 0.001). No periprocedural death, stroke, myocardial infarction, or transient ischaemic attack occurred. During 24-months follow-up, in 12 of 15 patients chronic ischaemia symptoms release was observed, and no new acute ischaemic neurological symptoms were diagnosed in all patients. One patient died 20 months after intervention from unknown causes. There was one symptomatic borderline VA in-stent stenosis 12 months after angioplasty.

Conclusions: Transradial VA stenting may be a very effective and safe procedure, and it may constitute an alternative to the femoral approach in patients with symptomatic VA stenosis.

No MeSH data available.


Related in: MedlinePlus