Endovascular stenting for vertebral artery stenosis

Area of Science:

• Vascular Surgery
• Interventional Neurology
• Cardiovascular Medicine

Background:

• Symptomatic vertebral artery stenosis (VAS) poses a significant stroke risk (30-35% over 5 years).
• High mortality (nearly 30% at 2 years) is associated with medically managed posterior circulation strokes.
• Surgical bypass for VAS is often avoided due to high morbidity and mortality risks.

Purpose of the Study:

• To evaluate the safety and long-term durability of catheter-based stenting for symptomatic vertebral artery stenosis (VAS).
• To assess endovascular revascularization as a treatment option for patients with symptomatic VAS.

Main Methods:

• A cohort of 105 consecutive patients with symptomatic VAS underwent stent placement.
• Procedures included treatment for extracranial (91%) and intracranial (9%) VAS.
• Patient data included bilateral VAS, concomitant carotid disease, and prior stroke history.

Main Results:

• 100% procedural success and 90.5% clinical success were achieved.
• At 1-year follow-up, 79.3% of patients remained symptom-free.
• Long-term follow-up (median 29.1 months) showed 70.5% remained symptom-free, with 71.4% alive.

Conclusions:

• Endovascular stenting for symptomatic VAS is safe and highly effective, with a 100% success rate in experienced hands.
• The procedure is associated with minimal periprocedural complications.
• Durable symptom resolution (approx. 80%) supports considering endovascular stenting as a first-line therapy for VAS.