• Meimei Zheng, Jinping Zhang, Yun Song, Wei Zhao, Lili Sun, Jun Zhang, Hao Yin, Wei Wang, and Ju Han.
• Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Lixia District, Jinan, China; Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Lixia District, Jinan, China.
• World Neurosurg. 2020 Mar 1; 135: 316-323.

ObjectiveEndovascular recanalization of symptomatic vertebral ostial occlusion in the nonacute phase has not been well documented. Distal thromboembolic events negatively affect the success of endovascular treatment. We aimed to investigate the feasibility, safety, and outcomes of stenting performed with the use of a distal embolic protection device for patients with symptomatic vertebral ostial occlusion in the nonacute phase.MethodsWe retrospectively reviewed the data of 7 patients with symptomatic vertebral ostial occlusion despite medical management who underwent stenting performed using a distal embolic protection device between January 2015 and February 2019. The occlusive lesions were predilated with small balloons, followed by placement of distal embolic protection devices and stents sequentially. At last, the protection devices were retrieved. The rate of successful recanalization, perioperative complications, and clinical and angiographic outcomes were analyzed.ResultsThe rate of successful recanalization was 100% with all distal embolic protection devices deployed and retrieved. Poststenting angiography showed no significant residual stenosis. There were no major acute thromboembolic events during and after the procedure. There were no recurrent ischemic symptoms after a mean clinical follow-up of 20.6 ± 16.3 months. At 6-month imaging follow-up, repeat vascular images from 5 patients showed asymptomatic restenosis in 1 artery.ConclusionsOur single-center preliminary experience indicated that performing stent placement for vertebral ostial occlusion using a distal protection device may be feasible with a high rate of procedural success. However, this strategy should be confirmed in future prospective randomized studies with larger patient numbers.Copyright © 2019 Elsevier Inc. All rights reserved.

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