Comparison of Self-Expanding Stents With Distal Embolic Protection to Balloon-Expandable Stents Without a Protection Device in the Treatment of Symptomatic Vertebral Artery Origin Stenosis: A Prospective Randomized Trial
机构：[1]China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China中美神经科学研究所首都医科大学宣武医院[2]Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA[3]Department of Vascular Surgery, Luhe Hospital, Capital Medical University, Beijing, China[4]Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China神经外科首都医科大学宣武医院[5]Department of Neurology, Central Hospital of Shengli Oilfield, Dongying, China
Purpose: To compare the angiographic and clinical outcomes of self-expanding stents (SES) with distal embolic protection devices (EPD) vs balloon-expandable stents (BES) without EPD in the treatment of symptomatic atherosclerotic vertebral artery ostial stenosis (VAOS). Methods: Between July 2011 and March 2013, a prospective randomized trial was conducted involving 127 patients (mean age 67.3 +/- 10.2 years; 94 men) with symptomatic VAOS randomly assigned to treatment with SES + EPD (Precise RX or RX Acculink stent + Spider FX EPD; n=61) or BES (Palmaz Blue or Resolute RX; n=66) without EPD. In-stent restenosis (ISR) >50% detected by duplex ultrasound was the primary endpoint. Technical success, clinical success, complications within 30 days, and signal intensity abnormalities on diffusion weighted imaging (DWI) after stenting were compared. Results: The 30-day technical success rate was 95.5% (63/66) for SES+EPD vs 100% (70/70) for BES without EPD (p=0.072). DWI at 24 hours poststenting showed 2 hyperintense lesions in 2 (3.3%) SES + EPD cases and 15 hyperintense lesions in 13 (18.6%) BES patients (p<0.01). At a mean 18-month follow-up, the clinical success rate was 93.9% (62/66) for the SES + EPD group vs 85.7% (60/70) for the BES group (p=0.115). The ISR was seen in 16/70 (22.9%) arteries in the BES group and 2/66 (3.1%) arteries in SES + EPD group (p<0.01). Target vessel revascularization was performed in 7 (10.0%) BES arteries vs none in the SES + EPD group (p<0.01). Conclusion: SES with EPD in the treatment of symptomatic VAOS is technically feasible and safe, with low rates of ISR and significantly reduced thromboembolic events on imaging when compared to BES without EPD.
基金：
the National Outstanding Youth Science Fund (No. 81325007)
the National Basic Research Program of China (973 Program, No. 2011CB707804).
第一作者机构：[1]China-America Institute of Neuroscience, Luhe Hospital, Capital Medical University, Beijing, China[2]Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
共同第一作者：
通讯作者：
通讯机构：[*1]Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.[*2]Department of Neurological Surgery, Wayne State University School of Medicine, 550 East Canfield, Detroit, MI 48201, USA.
推荐引用方式(GB/T 7714)：
Xiaokun Geng ,Mohammed Hussain ,Huishan Du ,et al.Comparison of Self-Expanding Stents With Distal Embolic Protection to Balloon-Expandable Stents Without a Protection Device in the Treatment of Symptomatic Vertebral Artery Origin Stenosis: A Prospective Randomized Trial[J].JOURNAL OF ENDOVASCULAR THERAPY.2015,22(3):436-444.doi:10.1177/1526602815579406.
APA：
Xiaokun Geng,,Mohammed Hussain,,Huishan Du,,Liang Zhao,,Jian Chen,...&Xunming Ji,.(2015).Comparison of Self-Expanding Stents With Distal Embolic Protection to Balloon-Expandable Stents Without a Protection Device in the Treatment of Symptomatic Vertebral Artery Origin Stenosis: A Prospective Randomized Trial.JOURNAL OF ENDOVASCULAR THERAPY,22,(3)
MLA：
Xiaokun Geng,,et al."Comparison of Self-Expanding Stents With Distal Embolic Protection to Balloon-Expandable Stents Without a Protection Device in the Treatment of Symptomatic Vertebral Artery Origin Stenosis: A Prospective Randomized Trial".JOURNAL OF ENDOVASCULAR THERAPY 22..3(2015):436-444
