Vascular recanalizing techniques in the hind brain circulation

Area of Science:

• Vascular Surgery
• Neurology
• Interventional Radiology

Background:

• Subclavian steal syndrome and vertebro-basilar occlusive disease pose significant clinical challenges.
• Effective treatment strategies for these conditions are crucial for patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) for subclavian steal syndrome and vertebral artery stenosis.
• To assess the effectiveness of intraarterial fibrinolytic therapy for acute vertebro-basilar occlusive events.

Main Methods:

• Percutaneous transluminal angioplasty (PTA) was performed in patients with subclavian steal syndrome and bilateral vertebral artery occlusions.
• Intraarterial fibrinolytic therapy using streptokinase or urokinase was administered to patients with acute vertebro-basilar or basilar artery occlusion.

Main Results:

• Two-thirds of patients with subclavian steal syndrome benefited from PTA, with a low restenosis rate.
• PTA for bilateral vertebral artery occlusions resulted in marked improvement in 8 out of 13 examined patients.
• Intraarterial fibrinolytic therapy demonstrated a 33% survival rate in patients with incomplete or progressive deficits, with no survivors in those with severe initial deficits.

Conclusions:

• PTA is an effective treatment for subclavian steal syndrome and selected cases of vertebral artery stenosis.
• Local intraarterial fibrinolytic therapy represents the primary successful treatment for progressive stroke due to vertebro-basilar thrombosis.