Risk Factors for Restenosis After Stenting or Angioplasty of Vertebral Artery Origin

Results of Short-term and Long-term Follow-up

Abstract

Background and Purpose

Endovascular treatment represents a well-established therapeutic option in patients with vertebral artery origin (VAO) stenosis. Our aim was to determine which factors affect short- and long-term restenosis rates after endovascular VAO therapy.

Methods

We conducted a single center analysis of 52 patients (36 men; age 64 ± 9.54 years) who underwent 55 endovascular procedures (27 balloon-assisted angioplasty [BAA], 28 stent-assisted angioplasty [SAA]) between 2005–2015. We collected data on patients clinical characteristics, medication and post-interventional follow-up visits.

Results

Overall, 15 of 55 vessels (27%) showed ≥70% restenosis at 1 year (short-term follow-up) and 18 after a mean follow-up of 52.9 ± 31.8 months (long-term). BMI ≥ 25 kg/m2 was associated with ≥70% restenosis in short-term (P = 0.014) and long-term (P = 0.003) follow-up. Other risk factors, namely, hypertension, ischemic heart disease, smoking, diabetes mellitus, hypercholesterolemia, atrial fibrillation, CRP (>5 mg/l) or pre-treatment antiplatelet administration, statin intake and platelet count, were not associated with restenosis risk in the entire cohort or in patients in the BAA group (all P > 0.05). BMI (P = 0.003) and ischemic heart disease (P = 0.041) were, in turn, associated with restenosis risk in the long-term follow-up in the SAA group. Patients undergoing BAA developed less frequently (P = 0.032) restenosis (18%) during long-term follow-up as compared to patients treated by stenting (46%).

Conclusion

BMI ≥ 25 kg/m2 increases the odds for ≥70% restenosis of VAO while ischemic heart disease represents an additional risk factor in stented patients. Further studies are required to established therapeutic strategies lowering the restenosis rates in overweight individuals after VAO therapy, especially ones undergoing stenting.

This is a preview of subscription content, log in to check access.

Abbreviations

BAA:

Balloon-assisted angioplasty

BMS:

Bare metal stents

BMT:

Best medical therapy

CDU:

Color Doppler ultrasound

CRP:

C-reactive protein

CT:

Computed tomography

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiography

DES:

Drug-eluting stent

MR:

Magnetic resonance

MRA:

Magnetic resonance angiography

NASCET:

North American Symptomatic Carotid Endarterectomy Trial

PTA:

Percutaneous transluminal angioplasty

SAA:

Stent-assisted angioplasty

TIA:

Transient ischemic attack

VA:

Vertebral artery

VAO:

Vertebral artery origin

VAST:

Vertebral Artery Stenting Trial

VIST:

Vertebral Artery Ischaemia Stenting Trial

References

  1. 1.

    Moulin S, Leys D. Management of acute cerebral ischaemia. Presse Med. 2016;45:451–5.

    Article  Google Scholar 

  2. 2.

    Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet. 2006;367:1747–57.

    Article  Google Scholar 

  3. 3.

    Béjot Y, Bailly H, Durier J. Maurice Giroud epidemiology of stroke in Europe and trends for the 21st century. Presse Med. 2016;45:391–8.

    Article  Google Scholar 

  4. 4.

    Caplan LR, Amarenco P, Rosengart A, Lafranchise EF, Teal PA, Belkin M, DeWitt LD, Pessin MS. Embolism from vertebral artery origin occlusive disease. Neurology. 1992;42:1505–12.

    CAS  Article  Google Scholar 

  5. 5.

    Wityk RJ, Chang HM, Rosengart A, Han WC, DeWitt LD, Pessin MS, Caplan LR. Proximal extracranial vertebral artery disease in the new england medical center posterior circulation registry. Arch Neurol. 1998;55:470–8.

    CAS  Article  Google Scholar 

  6. 6.

    Koch S, Amir M, Rabinstein AA, Reyes-Iglesias Y, Romano JG, Forteza A. Diffusion-weighted magnetic resonance imaging in symptomatic vertebrobasilar atherosclerosis and dissection. Arch Neurol. 2005;62:1228–31.

    Article  Google Scholar 

  7. 7.

    Bogousslavsky J, Van Melle G, Regli F. The Lausanne stroke registry: Analysis of 1,000 consecutive patients with first stroke. Stroke. 1988;19:1083–92.

    CAS  Article  Google Scholar 

  8. 8.

    Mazighi M, Labreuche J, Gongora-Rivera F, Duyckaerts C, Hauw JJ, Amarenco P. Autopsy prevalence of proximal extracranial atherosclerosis in patients with fatal stroke. Stroke. 2009;40:713–8.

    Article  Google Scholar 

  9. 9.

    Wang J, Zhong C, Zhang Y, Wei Y, Liu H, Wu C, Yan Y. Seven years’ follow-up of comparative study between stenting and medication for treatment of symptomatic vertebrobasilar artery stenosis. Interv Neuroradiol. 2017;24:43–50.

    Article  Google Scholar 

  10. 10.

    The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study group. Prognosis of patients with symptomatic vertebral or basilar artery stenosis. Stroke. 1998;29:1389–92.

    Article  Google Scholar 

  11. 11.

    Markus HS, Larsson SC, Kuker W, Schulz UG, Ford I, Rothwell PM, Clifton A; VIST Investigators. Stenting for symptomatic vertebral artery stenosis: The Vertebral Artery Ischaemia Stenting Trial. Neurology. 2017;89:1229–36.

    Article  Google Scholar 

  12. 12.

    Compter A, van der Worp HB, Schonewille WJ, Vos JA, Boiten J, Nederkoorn PJ, Uyttenboogaart M, Lo RT, Algra A, Kappelle LJ, VAST investigators. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: A randomised open-label phase 2 trial. Lancet Neurol. 2015;14:606–14.

    Article  Google Scholar 

  13. 13.

    Maisel WH. Unanswered questions-drug-eluting stents and the risk of late thrombosis. N Engl J Med. 2007;356:981–4.

    CAS  Article  Google Scholar 

  14. 14.

    Curfman GD, Morrissey S, Jarcho JA, Drazen JM. Drug-eluting coronary stents-promise and uncertainty. N Engl J Med. 2007;356:1059–60.

    CAS  Article  Google Scholar 

  15. 15.

    Cloud GC, Crawley F, Clifton A, McCabe DJH, Brown MM, Markus HS. Vertebral artery origin angioplasty and primary stenting: Safety and restenosis rates in a prospective series. J Neurol Neurosurg Psychiatry. 2003;74:586–90.

    CAS  Article  Google Scholar 

  16. 16.

    European Carotid Surgery Trialists’ Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: Final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351:1379–87.

    Article  Google Scholar 

  17. 17.

    Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, Rankin RN, Clagett GP, Hachinski VC, Sacket DL, Thorpe KE, Meldrum HE, Spence JD, North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med. 1998;339:1415–25.

    CAS  Article  Google Scholar 

  18. 18.

    Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, Warlow CP, Barnett HJ; Carotid Endarterectomy Trialists’ Collaboration. Analysis of pooled data from the randomised controlled trials of endarterec-tomy for symptomatic carotid stenosis. Lancet. 2003;361:107–16.

    CAS  Article  Google Scholar 

  19. 19.

    U-King-Im JM, Trivedi RA, Cross JJ, Higgins NJ, Hollingworth W, Graves M, Joubert I, Kirkpatrick PJ, Antoun NM, Gillard JH. Measuring carotid Stenosis on contrast-enhanced magnetic resonance Angiography. Diagnostic performance and Reproducibility of 3 different methods. Stroke. 2004;35:2083–8.

    Article  Google Scholar 

  20. 20.

    Antoniou GA, Murray D, Georgiadis GS, Antoniou SA, Schiro A, Serracino-Inglott F, Smyth JV. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg. 2012;55:1167–77.

    Article  Google Scholar 

  21. 21.

    Taylor RA, Siddiq F, Suri MF, Martin CO, Hayakawa M, Chaloupka JC. Risk factors for in-Stent Restenosis after vertebral ostium Stenting. J Endovasc Ther. 2008;15:203–12.

    Article  Google Scholar 

  22. 22.

    Ritchie SA, Connell JM. The link between abdominal obesity, metabolic syndrome and cardiovascular disease. Nutr Metab Cadiovasc Dis. 2007;17:319–26.

    CAS  Article  Google Scholar 

  23. 23.

    Kurth T, Gaziano JM, Berger K, Kase CS, Rexrode KM, Cook NR, Buring JE, Manson JE. Body mass index and the risk of stroke in men. Arch Intern Med. 2002;162:2557–62.

    Article  Google Scholar 

  24. 24.

    Rost NS, Wolf PA, Kase CS, Kelly-Hayes M, Silbershatz H, Massaro JM, D’Agostino RB, Franzblau C, Wilson PW. Plasma concentration of C‑reactive protein and risk of ischemic stroke and transient ischemic attack: The Framingham study. Stroke. 2001;32:2575–9.

    CAS  Article  Google Scholar 

  25. 25.

    Lehman SJ, Massaro JM, Schlett CL, O’Donnell CJ, Hoffmann U, Fox CS. Peri-aortic fat, cardiovascular disease risk factors, and aortic calcification: The Framingham Heart Study. Atherosclerosis. 2010;210:656–61.

    CAS  Article  Google Scholar 

  26. 26.

    Galic S, Oakhill JS, Steinberg GR. Adipose tissue as an endocrine organ. Mol Cell Endocrinol. 2010;316:129–39.

    CAS  Article  Google Scholar 

  27. 27.

    Britton KA, Fox CS. Perivascular adipose tissue and vascular disease. Clin Lipidol. 2011;6:79–91.

    CAS  Article  Google Scholar 

  28. 28.

    Zhang H, Zhang C. Regulation of microvascular function by adipose tissue in obesity and Type 2 diabetes: Evidence of an adipose-vascular loop. Am J Biomed Sci. 2009;1:133–42.

    CAS  Article  Google Scholar 

  29. 29.

    Hainer V, Aldhoon-Hainerová I. Obesity paradox does exist. Diabetes Care. 2013;36 Suppl 2:S276–81.

    Article  Google Scholar 

  30. 30.

    Chen X, Huang Q, Hong B, Zhang Y, Xu Y, Liu J. Drug-eluting stent for the treatment of symptomatic vertebral origin stenosis: long-term results. J Clin Neurosci. 2011;18:47–51.

    Article  Google Scholar 

  31. 31.

    Hatano T, Tsukahara T, Miyakoshi A, Arai D, Yamaguchi S, Murakami M. Stent placement for atherosclerotic stenosis of the vertebral artery ostium: Angiographic and clinical outcomes in 117 consecutive patients. Neurosurgery. 2011;68:108–16.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Malgorzata Wolska-Krawczyk.

Ethics declarations

Conflict of interest

M. Wolska-Krawczyk, M. Drunck, S. Behnke and W. Reith declare that they have no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wolska-Krawczyk, M., Drunck, M., Behnke, S. et al. Risk Factors for Restenosis After Stenting or Angioplasty of Vertebral Artery Origin. Clin Neuroradiol 30, 355–362 (2020). https://doi.org/10.1007/s00062-019-00768-2

Download citation

Keywords

  • BMI
  • Ostium
  • Overweight
  • Stenosis
  • Follow-up