Angioplasty and stenting of extracranial vertebral artery stenosis

Percutaneous angioplasty and stent placement seem a useful technique for the treatment of vertebro-basilar insufficiency and the first treatment to be proposed. This technique appears safe and effective for alleviating symptoms and improving blood flow to the cerebral circulation, with a low complications rate and good long-term results. However, this procedure needs experienced interventionists to choose the stent and have appropriate placement of the stent in the ostium of the vertebral artery (VA). The tortuosity of the VA may be technically challenging. The new coronary stents seem to be well suited to treat atherosclerotic lesions of the origin and of the proximal VA. A large variability of restenosis risk has been reported. Drug eluting stents may be the solution. Prospective randomized studies are needed to demonstrate the clinical effectiveness of VA stenting in stroke prevention, its durability, and to define more clearly its indications.