Our Experiences with Vertebral Artery Stents

Abstract

Objective: This study aimed to evaluate the success and clinical outcomes of endovascular stent treatment in vertebral artery (VA) occlusive lesions.
Methods: A total of 103 patients who underwent endovascular treatment due to VA constriction were included in this study. The patients were diagnosed on the basis of their clinical manifestations (vertigo, visual complaints, syncope, ataxia, drop attack, ischemic stroke, and transient ischemic attack (TIA)), neurological examinations, Doppler ultrasonography examination, and digital subtraction angiography (DSA). For angiographic evaluation, all patients underwent four vessel angiographies including the aortic arch, VA, and carotid artery. Anterior circulation, posterior circulation, and the Willis polygon were evaluated for all patients. During the procedure, the patients were not sedated, and neurological findings were continuously monitored.
Results: Thirty-six patients had stents implanted in their right vertebral arteries, 16 patients in their left vertebral arteries, and 3 patients in both vertebral arteries. During the procedure, bradycardia developed in three cases, and atropine was administered for its intervention. Hypotension developed in two cases, and dopamine along with 0.9% NaCl was administered for its intervention. One of the patients developed a speech disorder along with a complaint of imbalance 24 hours after the procedure. A magnetic resonance imaging (MRI) examination revealed an infarct on the left posterior inferior cerebellar artery (PICA) supply area. The patients’ symptoms subsided with minimal sequelae. Two patients had TIAs with complaints of dizziness and weakness on the left side. Hemorrhage and hematoma developed in the femoral artery region 2 hours after the stent implantation in two cases. One unit transfusion was applied.
Conclusion: Vertebral artery stenosis is one of the correctable causes of posterior systemic stroke and can now be diagnosed with more ease with the use of modern imaging methods. Balloon angioplasty or stent-assisted endovascular treatment is an effective treatment with low morbidity and mortality for patients with a single VA or who do not respond to medical treatment due to cerebral vascular pathology.