Vertebral Artery Stenosis: A Narrative Review

Area of Science:

• Vascular Neurology
• Cardiovascular Medicine
• Radiology

Background:

• Vertebral artery stenosis (VAS) accounts for about 20% of ischemic strokes in the posterior circulation.
• Common etiologies include atherosclerosis, calcification, dissection, fibromuscular dysplasia, giant cell arteritis, neurofibromatosis type 1, and bony compression.
• Atherosclerosis, driven by oxidized LDLs and cholesterol, is the most frequent cause of VAS.

Purpose of the Study:

• To review the causes, diagnosis, and treatment of vertebral artery stenosis.
• To highlight the shift towards non-invasive diagnostic techniques.
• To outline current and recommended therapeutic strategies for VAS.

Main Methods:

• Literature review of vertebral artery stenosis causes and treatments.
• Discussion of diagnostic modalities including digital subtraction angiography (DSA), duplex ultrasonography (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA).
• Analysis of current treatment paradigms for asymptomatic and symptomatic VAS.

Main Results:

• Multiple factors contribute to VAS, with atherosclerosis being predominant.
• While DSA is the gold standard, non-invasive methods like DUS, CTA, and MRA are increasingly utilized due to lower risks.
• Risk factor modification and medical management are standard for all VAS, with surgical and endovascular options for symptomatic cases.

Conclusions:

• Vertebral artery stenosis is a significant risk factor for ischemic stroke.
• A combination of diagnostic tools and therapeutic approaches are employed for effective management.
• Personalized treatment strategies are crucial for patients with symptomatic VAS.