Vertebral Insufficiency: When to Intervene and How?

Percutaneous transluminal angioplasty and stenting of supra-aortic atherosclerotic vascular obstructions is becoming relatively common in the innominate, subclavian, and carotid arteries. However, percutaneous revascularization of atherosclerotic vertebral artery disease is an infrequently used treatment option. We believe that angioplasty and stent placement of posterior circulation, symptomatic, vertebrobasilar atherosclerotic disease is a safe and effective approach which avoids the morbidity associated with major surgery. Surgical revascularization of symptomatic vertebral artery stenosis is rarely performed due to limited surgical success and increased surgical morbidity. Balloon angioplasty alone or combined with stenting is associated with high success rates and low restenosis rates, although there is a scarcity of published peer-reviewed data. Series of endovascular stent placement in vertebral arteries alone for the treatment of posterior circulation ischemia is unpublished.Typical posterior circulation (vertebrobasilar) ischemic symptoms include diplopia, dizziness, drop attack, gait disturbance, or a transient ischemic attack. Initial treatment is with anticoagulation or antiplatelet therapy. We believe primary stent placement is the treatment of choice for vertebral artery revascularization due to the high technical success rate, low incidence of morbidity and mortality, and long-term durability.