Endovascular Treatment of Extracranial Atherosclerosis
Endovascular Treatment of Extracranial Atherosclerosis
A retrospective analysis of patients who had undergone stent placement for symptomatic atherosclerotic disease involving the extracranial vertebral arteries was performed under an institutional review board approved protocol. A total of 24 consecutive patients over a 3-year period were included. Demographic, procedural and follow-up data were collected for all patients.
All patients had neurological symptoms referable to the diseased vertebral artery with or without MRI correlation. All patients, with one exception, had undergone an unsuccessful trial of single or dual antiplatelet treatment. The one patient who was treated without a trial of antiplatelet treatment had severe bilateral vertebral artery disease and unstable symptoms.
Procedures were performed with conscious sedation and after at least 3–5 days of dual antiplatelet preparation with aspirin and clopidogrel. Weight-based intraprocedure heparin was administered to maintain an activated clotting time around or above 250 s. Of the 28 stents, 25 were deployed through a transfemoral approach while radial access was utilized in 2 procedures and brachial access in 1 procedure. Pre-stent angioplasty was performed in 3 of 28 procedures and post-stent dilatation was performed in only 1 procedure. All stent procedures were performed without the use of distal protection. Post-procedure recovery included an overnight stay in the intensive or intermediate care unit and then either discharge to home or further observation in the neurology ward.
Materials and Methods
A retrospective analysis of patients who had undergone stent placement for symptomatic atherosclerotic disease involving the extracranial vertebral arteries was performed under an institutional review board approved protocol. A total of 24 consecutive patients over a 3-year period were included. Demographic, procedural and follow-up data were collected for all patients.
Inclusion Criteria
All patients had neurological symptoms referable to the diseased vertebral artery with or without MRI correlation. All patients, with one exception, had undergone an unsuccessful trial of single or dual antiplatelet treatment. The one patient who was treated without a trial of antiplatelet treatment had severe bilateral vertebral artery disease and unstable symptoms.
Technique
Procedures were performed with conscious sedation and after at least 3–5 days of dual antiplatelet preparation with aspirin and clopidogrel. Weight-based intraprocedure heparin was administered to maintain an activated clotting time around or above 250 s. Of the 28 stents, 25 were deployed through a transfemoral approach while radial access was utilized in 2 procedures and brachial access in 1 procedure. Pre-stent angioplasty was performed in 3 of 28 procedures and post-stent dilatation was performed in only 1 procedure. All stent procedures were performed without the use of distal protection. Post-procedure recovery included an overnight stay in the intensive or intermediate care unit and then either discharge to home or further observation in the neurology ward.
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