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Vertebral Insufficiency: When to Intervene and How?
1Ochsner Heart and Vascular Institute, Department of Cardiology, 1514 Jefferson Highway, New Orleans, LA 70121, USA. SJenkins@ohvi.ochsner.org
Insights
Percutaneous stenting is a safe and effective treatment for symptomatic vertebral artery disease, offering an alternative to surgery. This approach provides high success rates and long-term durability for posterior circulation ischemia.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiology
Background:
- Percutaneous transluminal angioplasty and stenting are common for supra-aortic arteries but less so for vertebral arteries.
- Surgical revascularization of symptomatic vertebral artery stenosis has limited success and high morbidity.
- Posterior circulation ischemic symptoms include diplopia, dizziness, and transient ischemic attacks.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous revascularization for atherosclerotic vertebral artery disease.
- To present angioplasty and stent placement as a viable alternative to surgical intervention.
- To highlight primary stent placement as the preferred treatment for vertebral artery revascularization.
Main Methods:
- Review of endovascular stent placement in vertebral arteries for posterior circulation ischemia.
- Analysis of angioplasty and stenting procedures for atherosclerotic vertebral artery disease.
- Comparison of outcomes between percutaneous revascularization and surgical options.
Main Results:
- Angioplasty and stenting of vertebral arteries demonstrate high success rates.
- Percutaneous revascularization is associated with low restenosis rates.
- This approach avoids the significant morbidity linked to major surgical procedures.
Conclusions:
- Percutaneous transluminal angioplasty and stenting of symptomatic vertebral artery disease is safe and effective.
- Primary stent placement is the recommended treatment for vertebral artery revascularization.
- Endovascular treatment offers high technical success, low complication rates, and long-term durability.
Abstract:
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.
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