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Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis
George A Antoniou1, David Murray, George S Georgiadis
1Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom. antoniou.ga@hotmail.com
Insights
Endovascular treatment for proximal vertebral artery disease, including angioplasty and stenting, shows low periprocedural risks. Further comparative studies are needed to fully assess treatment efficacy for cerebrovascular events.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Research
Background:
- Proximal vertebral artery atherosclerotic occlusive disease is a significant cause of cerebrovascular ischemic events.
- Endovascular treatment is a key therapeutic option alongside medical and surgical approaches.
- This review analyzes outcomes of endovascular management for proximal vertebral artery disease.
Purpose of the Study:
- To systematically review evidence on endovascular management of proximal vertebral artery disease.
- To analyze published outcomes of percutaneous transluminal angioplasty and stenting.
- To assess the efficacy and safety of endovascular interventions.
Main Methods:
- Systematic literature review of studies reporting angioplasty or stenting for proximal vertebral artery stenosis.
- Searched Medical Subject Headings terms: "vertebral artery," "angioplasty," "stents."
- Included studies with at least five patients; primary outcomes were periprocedural TIA, stroke, and death within 30 days.
Main Results:
- One RCT compared angioplasty/stenting with medical therapy; no endovascular vs. surgical repair comparisons found.
- 42 studies included 1099 patients (1117 arteries); weighted mean technical success rate was 97%.
- Periprocedural TIA: 1.5%; stroke/death: 1.1%; restenosis: 23%; reintervention: 9%.
Conclusions:
- Limited comparative evidence exists for medical, surgical, and endovascular treatments of proximal vertebral artery disease.
- Percutaneous transluminal angioplasty and stenting demonstrate low periprocedural neurologic adverse events and mortality.
- Further research is needed to establish optimal treatment strategies.
Background:
Atherosclerotic occlusive disease of the proximal vertebral artery is an important cause of cerebrovascular ischemic events with a significant associated morbidity and mortality. Endovascular treatment has emerged as a promising tool of the therapeutic armamentarium, along with medical therapy and surgical reconstruction. Our objective was to systemically review the pertinent evidence on the endovascular management of proximal vertebral artery disease and perform an analysis of the published outcomes.
Methods:
A systematic review of the literature identified all studies reporting percutaneous transluminal angioplasty or stenting, or both, for proximal vertebral artery stenosis. Web-based search engines were searched using the Medical Subject Headings terms "vertebral artery," "angioplasty," and "stents" in all possible combinations. Studies comprising a series of at least five patients were considered for analysis. Periprocedural transient ischemic attack and stroke and death from any cause ≤30 days of treatment were defined as the primary outcome end points.
Results:
One randomized controlled trial comparing angioplasty and stenting of the proximal vertebral artery and medical therapy was identified. No comparative studies of endovascular treatment and open surgical repair were found. Forty-two selected studies reported endovascular treatment (angioplasty or stenting, or both) of 1117 vertebral arteries in 1099 patients. The weighted mean technical success rate was 97% (range, 36%-100%). Periprocedural transient ischemic attack occurred in 17 patients (1.5%). The combined stroke and death rate was 1.1%. Recurrent symptoms of vertebrobasilar insufficiency developed in 65 of 967 patients (8%) within a reported follow-up of 6 to 54 months. Restenosis developed in 183 of 789 patients (23%) who underwent follow-up imaging (range, 0%-58%). Reintervention for recurrent disease during follow-up occurred in 86 patients (9%; range, 0%-35%).
Conclusions:
There is limited comparative evidence on the efficacy of medical, surgical, and endovascular treatment of proximal vertebral artery disease. Percutaneous transluminal angioplasty and stenting has low periprocedural neurologic adverse events and mortality.
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