Clinical Efficacy Of Drug-coated Balloon In The Treatment Of Symptomatic Vertebral Artery Origin Stenosis With Tortuous Lesions

BACKGROUND: Stroke has been shown to be the leading cause of death and disability in our population,with ischemic stroke accounting for up to 80% of cases.Atherosclerotic stenosis of the vertebral artery origin(VAOS)is one of the most important causes of ischemic stroke in the posterior circulation,with a prevalence of approximately 20% in the population,and tortuosity of the vertebral artery initiation segment often occurs when there is abnormal embryonic development or the presence of severe atherosclerotic lesions.Symptomatic VAOS is treated with traditional surgery,drugs,and endovascular therapy.Due to the poor safety of surgical procedures and the high mortality and disability rates,surgical treatment is no longer recommended clinically.With the continuous improvement of endovascular intervention,it has been widely recognized as the best treatment option for patients with VAOS due to its minimal trauma,extremely high technical success rate,and minimal perioperative complications.Currently,clinically,most patients with VAOS choose stenting with pharmacological treatment;however,there are some disadvantages to vertebral artery stenting,which has a significantly higher restenosis rate than the carotid artery,especially when VAOS is accompanied by tortuous lesions,the beginning curvature is unnaturally straightened due to stent placement,resulting in more severe injury than in flat arteries,and stent fracture is more likely to occur.As a result of stent fracture,fibroblast and neointima formation is greatly affected,leading to the development of in-stent restenosis.In order to effectively reduce the incidence of restenosis after VAOS stent placement,drug-eluting stent(DES)and drug-coated balloon(DCB)have been widely used in clinical practice,and their safety has been well proven.Studies have shown that DES has a lower restenosis rate than conventional bare metal stent(BMS)in the treatment of symptomatic VAOS patients,but when VAOS is combined with tortuous vessels,the restenosis rate of DES is significantly affected,while DCB can effectively reduce the incidence of restenosis through its unique advantages,thereby improving the patient’s condition.The precise positioning of DCB,which not only does not excessively cover the normal vessels but also maintains the normal curvature of the vessels,may be a safe and effective treatment method.The technical limitation of DCB is that it is less able to counteract the elastic retraction of blood vessels than BMS.Therefore,angioplasty using DCB for symptomatic VAOS with tortuous lesions is promising,but the clinical efficacy is uncertain and clinical trials are needed for evaluation.OBJECTIVE: This study attempted to explore the clinical efficacy of drug-coated balloons for the treatment of symptomatic vertebral artery initiation stenosis combined with tortuous lesions,to summarize and analyze the results of the study,to assess the clinical benefit of the new treatment modality and to analyze the factors associated with the rate of restenosis.METHODS: Patients with acute cerebral infarction who were admitted to the neurointerventional and critical care unit of Dalian Central Hospital from November2021 to July 2022 and whose presence of VAOS with tortuous lesions was confirmed by cerebral angiography were consecutively enrolled.The clinical data of all patients in the group were collected,and outpatient cervical ultrasound and telephone follow-up were performed in the first,third and sixth months after the operation.The clinical data and follow-up results of the enrolled patients were statistically analyzed.RESULTS: A total of 26 cases meeting the nadir criteria were finally enrolled,and all patients received endovascular treatment.There was no statistically significant difference in the effect of immediate postoperative stenosis relief between the DCB and BMS groups(P<0.05);0 endpoint events occurred in the DCB group and 7endpoint events occurred in the BMS group during the follow-up period,with statistically significant differences(P<0.05);patients were re-classified according to whether endovascular restenosis occurred.Patients were divided into the restenosis group and the no restenosis group,and the proportion of patients with smoking and previous stroke history was greater in the restenosis group than in the no restenosis group.CONCLUSION: Drug-coated balloons may be safe and feasible for the treatment of symptomatic vertebral artery stenosis with tortuous lesions,and the immediate postoperative relief of stenosis is not inferior to that of conventional stenting.Smoking,previous stroke history,and small preoperative vertebral artery diameter may influence the occurrence of restenosis.