Authors
Bocharov A.V.1, 2, Popov L.V.3, Mittsiev A.K.2, 4, Lagkuev M.D.2
1 Kostroma Regional Clinical Hospital named after Korolev E.I., Kostroma
2 Republican Clinical Hospital of the Ministry of Health of the Republic of North Ossetia-Alania, Vladikavkaz
3 Pirogov National Medical and Surgical Center, Moscow
4 North-Ossetian State Medical Academy, Vladikavkaz
Abstract
Rationale: the most common method of treating vertebral artery stenosis is stenting. There are isolated studies on the results of the use of drug-coated stents of the 1st generation in the above pathology, which showed significantly better results, but the use of drug-coated stents with a resorbable polymer coating (3rd generation) has not been studied at present.
Objective: to compare the long-term results of stenting of the 1st segment of the vertebral artery in symptomatic patients during implantation of holometallic stents and drug-coated stents.
Methods: a non-randomized comparative retrospective continuous study of the results of the use of various types of stents in stenotic lesions of the 1st segment of the vertebral arteries in symptomatic patients was conducted. Depending on the type of implanted stent, the patients were divided into 2 groups: the DES group included 46 patients who were implanted with a cobalt-chromium stent with a sirolimus drug coating and a resorbable polymer coating, and the BMS group included 39 patients who were implanted with holometallic cobalt — chromium stents. The follow-up period was 12 months. The assessment of long-term results was carried out at an outpatient appointment, the assessment of the presence of restenoses in the stenting zone of the vertebral artery was carried out using expert-class ultrasound systems.
Results: the groups were comparable in terms of the main clinical, demographic and angiographic indicators. There were no complications in the hospital period. There was a significant difference in the frequency of restenosis, which was significantly higher in the BMS group (2 (4.3%) and 17 (43.6%) in the DES and BMS groups, respectively, p = 0.0007). The risk of acute ischemic cerebral circulation disorder or transient ischemic attack due to the frequency of restenosis in the groups does not differ (OR = 3.75 at 95% CI [0.22; 62.76]). The patients ‘ adherence to drug therapy did not have significant differences between the groups.
Conclusion: in symptomatic patients with hemodynamically significant stenoses of the 1st segment of the vertebral arteries, the use of holometallic stents leads to a significantly higher number of restenoses compared to the use of sirolimus drug-coated stents with a resorbable polymer coating in the long-term period (2 (4.3%) and 17 (43.6%) in the DES and BMS groups, respectively, p = 0.0007). Despite the significantly higher incidence of restenosis in patients who were implanted halometasone stents (OR =17.95% CI [3,6; of 80.25]), a comparative analysis of the risk of occurrence of acute disorders of cerebral circulation by ischemic type or transient ischemic attack if you encounter destinationsa changes, no significant differences were observed (OR = 3.75 in 95 DI [0,22; 62,76]).
Keywords: stroke, stenosis, vertebral artery, stenting, drug-coated stents.
References
1. Meschia J, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American heart association. American stroke association. Stroke. 2014; 28: 1-79. doi: 10.1161/STR.0000000000000046.
2. Sun X, Ma N, Wang B, Mo D, et al. The long term results of vertebral artery ostium stenting in a single center. J. Neurointerv. Surg. 2015; 7(12): 888-891. doi: 10.1136/neurintsurg-2014-011356.
3. Jellinger PS, Handelsman Y, Rosenblit PD, et al. American association of clinical endocrinologists and American college of endocrinology guidlenes for management of dyslipidemia and prevention of cardiovascular disease. Endocrine Practice. 2017; 23(4): 479-497. doi: 10.4158/EP171764.GL.
4. Chechetkin AO, Skrylev SI, Koshcheev AJu, et al. Clinical and instrumental evaluation of vertebral arteries stenting efficiency in the short-term and long-term postoperative periods. Annals of clinical and experimental neurology. 2018; 12(3): 13-22 (In Russ). doi: 10.25692/ ACEN.2018.3.2.
5. Tsutsumi M, Kazekawa K, Onizuka M, et al. Stent fracture in revascularization for symptomatic ostial vertebral artery stenosis. Neuroradiology. 2007; 49(3): 253-257. doi: 10.15274/INR-2014-10068.
6. Lin YH, Hung ChSh, Tseng WY, et al. National Taiwan University Carotid Artery and Vertebral Artery Stenosis (NTU CAVAS) Study Group. Safety and feasibility of drug-eluting stent implantation at vertebral artery origin: the first case series in Asians. Med. Assoc. 2008; 107(3): 253-258. doi: 10.1016/S0929-6646(08)60144-8.
7. Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur. Heart J. 2018; 39(9): 763-816. doi: 10.1093/eurheartj/ehx095.
8. Suslina ZA, Guglevskaja TS, Maksimova MJu, et al. Narushenija mozgovogo krovoobrashchenija: diagnostika, lechenie, profilaktika. Moscow: MEDpress-infоrm, 2016 (In Russ).
9. Al-Ali F, Barrow T, Duan L, et al. Vertebral artery ostium atherosclerotic plaque as a potential source of posterior circulation ischemic stroke: result from borgess medical center vertebral artery ostium stenting registry. Stroke 2011; 42: 2544-2549. doi: 10.1161/STROKEAHA.110.610451.
10. Chen X, Huang Q, Hong B, et al. Drug-eluting stent for the treatment of symptomatic vertebral origin stenosis: Long-term results. J Clin Neurosci. 2011; 18: 47-51. doi: 10.1016/j.jocn.2010.05.023.
11. Fields J, Petersen B, Lutsep H, et al. Drug eluting stents for symptomatic intracranial and vertebral artery stenosis. Interv Neuroradiol 2011; 17: 241-247. doi: 10.1177/159101991101700217.
12. Antoniou G, Murray D, Georgiadis G, et al. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg. 2012; 55: 1167-1177. doi: 10.1016/j.jvs.2011.09.084.
13. Stayman A, Nogueira R, Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke 2011; 42: 2212-2126. doi: 10.1161/STROKEAHA.110.611459.
