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Vertebral Artery Interventions: A Comprehensive Updated Review
Oscar Maitas1, Tamunoinemi Bob-Manuel2, Justin Price1
1John Ochsner Heart and Vascular Center, New Orleans, LA, USA.
Current Cardiology Reviews
|March 18, 2022
Summary
Vertebral artery stenosis causes significant stroke risk. Percutaneous treatment offers promise but requires further study to confirm its superiority over medical therapy for preventing recurrent strokes.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Posterior circulation ischemia from vertebral artery stenosis constitutes 20-25% of ischemic strokes.
- High risk of recurrent stroke exists, especially early after symptom onset with medical therapy alone (10-15% annual rate).
- Vertebrobasilar obstructive disease has a poor prognosis (30% 2-year mortality) without intervention.
Approach:
- Review focuses on percutaneous transluminal angioplasty and stenting for symptomatic vertebral artery stenosis.
- Discusses diagnostic approaches and current medical therapy advancements.
- Examines clinical trial data on stenting versus medical therapy, noting limitations in sample size.
Key Points:
- Percutaneous angioplasty and stenting show good technical results but require larger trials to definitively prove clinical superiority over medical management.
- Surgical revascularization is an alternative with a 10-20% mortality rate.
- Despite therapeutic advances, vertebral artery stenosis remains a significant cause of stroke morbidity and mortality.
Conclusions:
- Symptomatic vertebral artery stenosis necessitates effective treatment strategies due to high stroke recurrence and mortality risks.
- Further research is crucial to establish optimal treatment paradigms, balancing risks and benefits of endovascular, surgical, and medical approaches.
- This review provides an update on percutaneous interventions and diagnostic considerations for vertebral artery stenosis.
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