Use of the Szabo Technique to Guide Accurate Stent Placement at the Vertebral Artery Ostium

PURPOSE: To evaluate the Szabo technique in stenting at the vertebral artery ostium. METHODS: Between 2010 and 2011, 26 patients (21 men; mean age 67 years) with symptomatic vertebral artery ostial stenosis >60% were treated. Under distal filter protection, a 0.014-inch guidewire was introduced in the ipsilateral subclavian artery as the marker wire for the Szabo technique. The balloon-expandable paclitaxel-embedded Yinyi stent was mounted on the filter's guidewire in a monorail configuration. One strut segment only of the last stent cell was gently flared by forceps, and the outer end of the marker wire was introduced through the flared strut of the stent. The lifted strut was then crimped back into place. Holding the two wires together, the stent/balloon system was gently advanced into the ostial lesion until the marker wire stopped advancing and resistance was appreciated. The stent was deployed at 6 atmospheres, after which the balloon was deflated to 2 to 4 atmospheres, the marker wire was withdrawn, and the stent was postdilated at a high pressure (10-12 atmospheres) after withdrawing the balloon one half to one third outside of the stent to ensure that the protruding strut was flush against the wall of the subclavian artery. RESULTS: The technical success rate was 100% with accurate stent deployment. The mean degree of stenosis reduced from 84.5%±6.1% to 6.2%±3.1%. Symptoms were resolved in 20 cases and were improved in 6 cases with prior stroke. No obvious in-stent restenosis was revealed by imaging at 12.0±2.2 months. No procedure-related stroke or transient ischemic attacks occurred at a follow-up for 24.0±3.7 months. CONCLUSION: The Szabo technique is safe and effective in guiding accurate placement of the Yinyi stent at the vertebral artery ostium, which may help lower restenosis rates.