Three-year outcomes of vertebral artery stenting in patients with asymptomatic cerebral ischemia

Objective. To evaluate 3-year outcomes of vertebral artery stenting in «asymptomatic» patients with atherosclerotic stenosis of the vertebral arteries as a method of secondary prevention of cerebrovascular disorders. Material and methods. In the group A (n=34), secondary prevention of cerebrovascular accidents was carried out using a combined strategy (vertebral artery stenting combined with medication), in the group B (n=36) — medication alone. Long-term outcomes were assessed after 12, 24 and 36 months. Inclusion criteria were «asymptomatic» patients with vertebral artery stenosis 50-95%; vertebral artery diameter 3-5 mm; cerebral and focal symptoms of initial (asymptomatic) stage of chronic brain ischemia (according to E.V. Schmidt grading system); presence of at least one factor of unfavorable prognosis of chronic cerebral ischemia (arrhythmia, total cholesterol over 6.0 mmol/l, open circle of Willis, arterial hypertension, bilateral lesion of the vertebral arteries, low-density lipoproteins over 3.5 mmol/l, combined lesion of the vertebral and carotid arteries, calcification of the vertebral arteries, previous coronary artery disease). Primary endpoint was overall incidence of cardiovascular complications (death, transient ischemic attack or stroke, myocardial infarction). Results. In group A, vertebral artery stenting was performed without protection devices. Overall incidence of major cerebral complications made up 5.9% in group A and 25% in group B (χ2=4.825; p=0.023). Overall incidence of stroke was 2.9% and 30.5%, respectively, transient cerebrovascular attacks — 5.8% and 8.3%, respectively (χ2=4.135; p=0.042), cardiac complications — 8.8% and 27.8%, respectively (χ2=4.154; p=0.042). Survival free from major cerebral and cardiac complications was significantly higher after combined treatment. Target total cholesterol values after 36 months were achieved in 88.2% of patients in group A and 83.3% in group B (p>0.05), LDL target values — 90.9% and 80.6%, respectively (p>0.05), triglycerides — 100% in both groups. In group A, restenosis-free survival was 94.1±4%. In general, restenosis occurred in 6.45% of patients after combined treatment. However, restenosis per se did not affect the incidence of major cerebral complications in long-term postoperative period (χ2=0.6911; p=0.4057). Conclusion. Secondary prevention of cerebrovascular disorders using combined treatment (vertebral artery stenting and drug therapy) is advisable in patients with atherosclerotic lesions of vertebral arteries, asymptomatic chronic cerebral ischemia and unfavorable prognostic factors. © 2020, Media Sphera Publishing Group. All rights reserved.