Author + information
- Received September 22, 2017
- Accepted September 26, 2017
- Published online March 5, 2018.
- YaBing Wang, MD,
- Yan Ma, MD,
- Peng Gao, MD,
- Yanfei Chen, MD,
- Bin Yang, MD and
- Liqun Jiao, MD∗ ()
- ↵∗Address for correspondence:
Dr. Liqun Jiao, Beijing Xuan Wu Hospital, Xicheng District, Beijing 100053, China.
A 65-year-old woman presented with a 2-month history of unexplained dizziness, vertigo, nausea, and vomiting. She had a more than 10-year history of essential hypertension with her blood pressure kept in a normal range by medications. Her neurological examination was unremarkable. Computed tomography angiography (CTA) showed left vertebral artery dominance and subtotal occlusion of the origin of the left vertebral artery (Figure 1A). After initiation of antiplatelet and antiemetic drug treatment, her symptoms improved but did not disappear. A cerebral angiogram confirmed the CTA findings and showed obvious tortuosity of the proximal left vertebral artery segment (Figures 1B and 1C). Given the tortuosity of the target lesion and the patient’s unwillingness to undergo stent implantation, treatment with a drug-coated balloon (DCB) was contemplated. She was carefully evaluated for planning the intervention and informed consent was obtained.
The percutaneous intervention of the left vertebral artery was performed under local anesthesia. After placement of an 8-F catheter sheath in femoral artery, an 8-F guide catheter was advanced to the subclavian artery over a 0.035-inch guidewire. Then a 0.014-inch microguidewire was passed through the vertebral artery stenosis into the V2 segment and a distal protection device was placed at the distal end of the V2 segment. After pre-dilation of the stenosis with a 3.0∗20 mm balloon, a 4.0∗40 mm Orchid DCB (Acotec Scientific, Beijing, China) was used. Inflation time was 60 s and inflation pressure was 8 atm. The final angiogram showed good patency of the left vertebral artery and no distal thromboembolism was found (Figures 2A and 2B). A vascular ultrasound examination performed the next day showed a return of blood flow velocity at the vertebral artery origin to normal (i.e., a decrease from 385 cm/s to 112 cm/s). The patient performed well after the procedure, and a post-procedural magnetic resonance imaging examination showed no abnormal signal intensities.
Six months later, follow-up including cervical Doppler ultrasound and CTA was performed to evaluate patency of the left vertebral artery. The sonographically measured flow velocity at the vertebral artery origin was 105 cm/s, similar to the velocity measured directly after the intervention. CTA confirmed adequate patency of the balloon-treated segment (Figure 3). So far, the patient’s symptoms have not recurred.
DCB has shown good results in controlling neointimal hyperplasia in the femoral and popliteal arteries (1), although its role in treating vertebral artery origin stenosis is still unknown. Although long-term outcome remains to be assessed, this first report of DCB angioplasty for vertebral artery origin stenosis is promising, because we show maintenance of patency at 6 months. These findings suggest that vertebral artery origin stenosis may be a potential novel indication for DCB, especially when patients are unsuitable for stent implantation or unwilling to undergo stenting.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 22, 2017.
- Accepted September 26, 2017.
- 2018 American College of Cardiology Foundation