A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

Abstract

Background and Purpose-Extracranial vertebral artery stenosis (ECVAS) is common among patients with ischemic stroke. Despite the limited knowledge of the natural history of patients with symptomatic vertebral disease, endovascular revascularization techniques are now utilized in clinical practice. We sought to determine the risk of endovascular treatment for ECVAS with a systematic review of the literature. Methods-A search strategy was used using the terms "stenting," "vertebral," "ostium," "origin," and "extracranial" through Medline. All articles were reviewed along with their references to determine the risk and durability of endovascular treatment. Results-A total of 27 articles were identified that met inclusion criterion, with a total of 980 of 993 patients treated with stents. The majority of patients (56%) were noted to have contralateral vertebral artery stenosis or occlusion and 92% were symptomatic at the time of treatment. A total of 11 patients (1.1%) experienced a stroke and 8 (0.8%) experienced a transient ischemic attack within 30 days of the procedure. Drug-eluting stents were associated with lower restenosis rates (11%) compared to bare metal stents (30%) at a mean of 24 months of follow-up. Conclusions-Stenting and angioplasty of ECVAS appear to have a low rate of periprocedural stroke or transient ischemic attack and restenosis rates that may not be as high as suspected. Given the frequency of ECVAS as an etiology for ischemic stroke, future studies aimed at determining efficacy of this treatment modality relative to medical therapy would be of benefit to clinicians caring for these patients. (Stroke. 2011;42:2212-2216.)

Endovascular Angioplasty for Extracranial Vertebral Artery Occlusion Without Visualization of the Stump of the Artery Ostium

“…3,9,14,21) However, a systematic review of percutaneous revascularization of extracranial VA stenosis found no differences in periprocedural stroke rates with or without protection devices. 16) Similarly, the endovascular treatment without an embolic protection device performed in our case did not result in procedural thromboembolic complication.…”

“…16) Stenting of a longsegment extracranial VA occlusion was also reported. 5) However, to our knowledge, no reports have described endovascular angioplasty of VA origin occlusion without visualization of the stump of the artery ostium.…”

“…This positioning of the stent with proximal protrusion into the large vessel can result in stent fracture. 16,20) However, stent fracture was reported to be associated with stent type, not vessel diameter, with the open-cell type of coronary stent exhibiting a high risk of fracture. 17) We used the present stent due to its closed-cell design, and its conformability and flexibility for tortuous vessels such as the renal artery, which was originally approved for the angioplasty.…”

“…13) Percutaneous endovascular treatment of extracranial VA disease is not as technically challenging as surgical procedures, and as such, endovascular angioplasty is a valuable alternative. 2,7,9,16,20,21) Common endovascular angioplasty is performed after a wire device is navigated across the lesion. However, if the origin of the VA is not visualized, manipulation of the wire may be difficult.…”

Vertebral artery transposition for revascularization of the posterior circulation: a critical assessment of temporary and permanent complications and outcomes

“…Furthermore, the effect of novel agents, including antiplatelet agents and statins, on altering the natural history of these lesions is less well studied. Recent attempts at the use of stenting and/or angioplasty for these lesions has produced mixed results 1,8,26,27 and significant rates of restenosis, ranging from 11% for drug-eluting stents to more than 30% for bare-metal stents.Microsurgical revascularization of the proximal VA has been well described, but the majority of published series included small patient populations and short follow-up ObJect Despite advances in medical management and endovascular therapies, including the introduction of statins, antiplatelet agents, and drug-eluting stents, some patients experience medically refractory vertebrobasilar insufficiency and may benefit from robust surgical revascularization. The aim of this study was to evaluate such patients after surgical revascularization, emphasizing long-term outcomes and rates of complications.…”