Jenkins et al. Vertebral Artery Intervention
JACC Vol. 55, No. 6, 2010 February 9, 2010:538–42
went successful endovascular stenting, with no strokes or death occurring within 30 days in either group. At mean follow-up of 4.7 years, there were no vertebral strokes in either group. A Cochrane Review identified 173 cases of VAS stenting of 313 cases of vertebral artery intervention (34). Analysis of these 20 studies found a 30-day major stroke and death rate of 3.2% and a 30-day TIA and nondisabling stroke rate of 3.2%. This meta-analysis suggests that vertebral artery stenting is safe and effective, although a selection bias exists. Over the last 2 decades, catheter-based treatment of PAD has become the preferred therapy compared with surgical revascularization. Treatment of VAS has evolved more slowly than endovascular therapies in the iliac, renal, and coronary arteries. A major impediment to treatment has been a nonpayment decision by Medicare in 1984. However, since that time there have been significantly more favorable data supporting the safety, efficacy, and benefit of VAS. Nonpayment for percutaneous vertebral artery therapies is difficult to understand in view of the positive track record for percutaneous transluminal angioplasty and stenting in other vascular territories and the lack of treatment alternatives for a disease with a 2-year mortality for medically treated VBS disease of 30% and a combined surgical morbidity/ mortality of 25%. Therefore, it seems appropriate that this nonpayment decision be revisited. Study limitations. Our data reflect our clinical practice at the Ochsner Clinic Foundation, including dedicated high-volume interventionalists who benefited from the cooperation and support of a team of neurologists and neuroradiologists, and might not be reproducible under less ideal conditions. The major limitation of this study is its retrospective nature, which does not allow direct comparison with other treatment strategies. A minor limitation is the lack of angiographic core laboratory analysis. Conclusions Our results demonstrate the safety and feasibility of treating symptomatic vertebral artery stenotic lesions with endovascular stent therapy. The excellent safety results and durability of symptom-free outcomes support the efficacy of endovascular stent therapy for symptomatic VAS. Vertebral stenting offers a safer and less morbid alternative than open surgery and should become the preferred therapy for symptomatic vertebral artery atherosclerotic obstructive disease. Acknowledgments
The authors are thankful for the cooperation and support of a team of physicians including Kevin McKinley (neurology), Robert Felberg (neurology), and Robert Dawson (neuroradiology). The authors also thank Mr. James O’Meara and
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Mr. Darren Barre for assistance with the manuscript preparation and data collection. Reprint requests and correspondence: Dr. J. Stephen Jenkins, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, Louisiana 70121. E-mail: jsjenk@ bellsouth.net.
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