The ATTAIN Technique (Amplatz lefT guiding caTheter pArtIal deploymeNt): An Alternative Approach for Transradial Stenting of Low-Origin Vertebral Artery Ostial Stenosis.

Objective

To assess technical feasibility and procedural features of the Amplatz Left (AL) guiding catheter-assisted partial deployment (ATTAIN) technique for selected right-sided low-origin vertebral artery ostial stenosis (VAOS).

Methods

We prospectively studied 10 consecutive patients. Technical success required accurate balloon-expandable drug-eluting stent placement and expansion without access crossover, guide-catheter exchange, or salvage techniques. Safety outcomes included 30-day neurological and access-site events and follow-up stent-related events. Preprocedural assessment considered vertical ostial depth (VOD) and subclavian-vertebral geometry.

Results

During the 17-month enrollment period, technical success was achieved in 9 of 10 patients (90%). Median age was 71.5 years (IQR, 69-74); median VOD was 12.5 mm (IQR, 11-16). Among successful procedures, median deployment time was 28 minutes (IQR, 22-32). Median stenosis decreased from 76.5% (IQR, 73%-83%) to 2.5% (IQR, 0%-9%). At 3 months, symptoms completely resolved in 6 patients, partially improved in 2, and remained unchanged in 2; all had modified Rankin Scale scores of 0 or 1. No clinically apparent stroke, transient ischemic attack, or death occurred within 30 days; one unconfirmed minor access-site event was recorded. At a median 8-month follow-up (IQR, 5-11; range, 3-15), 9 patients underwent imaging, no stent fracture or in-stent restenosis was identified.

Conclusions

In this proof-of-concept series, the ATTAIN technique showed preliminary feasibility and provided a standardized AL guiding-catheter-assisted deployment sequence for selected right-sided low-origin VAOS. Comparative efficacy, definitive safety, and left-sided applicability remain unestablished.