|Year : 2018 | Volume
| Issue : 3 | Page : 115
Commentary on paper “Severe vertebral artery stenosis treated by directional atherectomy” by Yongquan Gu, et al. Vasc Invest Ther 2018;1:110-4
Department of Surgery, Imperial College London, London, UK; Department of Surgery, University of Nicosia Medical School, Egkomi, Cyprus
|Date of Web Publication||30-Apr-2019|
Imperial College London, London; University of Nicosia Medical School, Egkomi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nicolaides A. Commentary on paper “Severe vertebral artery stenosis treated by directional atherectomy” by Yongquan Gu, et al. Vasc Invest Ther 2018;1:110-4. Vasc Invest Ther 2018;1:115
|How to cite this URL:|
Nicolaides A. Commentary on paper “Severe vertebral artery stenosis treated by directional atherectomy” by Yongquan Gu, et al. Vasc Invest Ther 2018;1:110-4. Vasc Invest Ther [serial online] 2018 [cited 2019 Jul 20];1:115. Available from: http://www.vitonline.org/text.asp?2018/1/3/115/257418
Two randomized controlled trials, the vertebral artery ischemia stenting trial (VIST), and vertebral artery stenting trial revealed that stenting of extracranial vertebral artery stenosis can be performed with a low-operative stroke risk (0%–2%, respectively)., In VIST, the hazard ratio for stroke during follow-up was 0.34 (95% confidence interval 0.12–0.98; P = 0.046) after adjusting for days from last symptoms. Despite the relief of symptoms following extracranial vertebral artery stenting, there was a high rate of restenosis (15% and 22%, respectively).
Following percutaneous balloon angioplasty (PTA), early restenosis is caused by arterial wall recoil in cases with bulky fibrotic or calcified atherosclerotic plaques. Later restenosis is caused by intimal hyperplasia. The first cause can be avoided by atherectomy, and the second by the use of drug-coated balloons (DCB).
In patients with lower limb arterial disease, directional atherectomy using the Silverhawk atherectomy device (LS-M, Silverhawk, Medronic) which reduces plaque volume has been successful in improving claudication distance and increasing limb salvage by 83% at 3 years. In the absence of stenting, a 12-month patency rate of 77% has been reported. Although Silverhawk atherectomy in the lower limb provided good early results, intimal hyperplasia with a peak growth at 5–6 months remained a problem and hence that the results were not better than PTA alone.
Subsequently, several studies indicated that in patients with complex lesions in the lower limb arteries, the combination of atherectomy with PTA using a DCB yielded better outcomes.,
The application of directional atherectomy combined with DCB angioplasty for symptomatic severe vertebral artery lesions is a novel approach, and the authors should be congratulated. Although the feasibility and efficacy in relieving symptoms have been demonstrated, the long-term studies are needed to confirm these early results and determine the criteria for selection of patients.
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. Severe vertebral artery stenosis treated by directional atherectomy. Vasc Invest Ther 2018;1:110-4. [Full text]