Cervical vertebral angioplasty for brain stem ischemia

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• Extracranial arterial occlusive disease can cause stroke and transient ischemic attacks.
• Vertebral artery stenosis is a significant cause of vertebrobasilar insufficiency, leading to brain stem symptoms.
• Surgical intervention for vertebral artery disease has evolved, with varying indications and outcomes.

Purpose of the Study:

• To evaluate the long-term outcomes of unilateral vertebral arterial reconstructions.
• To assess the safety and efficacy of vertebral angioplasty for specific neurological symptoms.
• To determine the indications and effectiveness of vertebral procedures in patients with persistent symptoms after carotid intervention.

Main Methods:

• A retrospective review of 58 patients undergoing unilateral vertebral arterial reconstructions over 16 years.
• Analysis of procedures including subclavian-vertebral angioplasty and bypass grafting.
• Evaluation of patient symptoms, co-existing conditions, and long-term follow-up data including stroke rates and survival.

Main Results:

• Vertebral reconstruction, primarily subclavian-vertebral angioplasty, was performed for brain stem symptoms and persistent ischemia after carotid repair.
• Syncopal episodes were a major symptom, often controlled by vertebral procedures, though cardiac interventions were sometimes necessary.
• Long-term follow-up showed a low stroke rate (1.2% per patient-year) and sustained neurological stability in 70% of patients at 14 years, but overall survival was 45%, with myocardial infarction as the leading cause of death.

Conclusions:

• Vertebral angioplasty is indicated for bilateral vertebral arterial flow-obstructing lesions in patients with brain stem ischemia, especially when symptoms persist after carotid lesion correction.
• The procedure can be performed with a high degree of safety.
• Differential diagnosis for drop attacks and syncope should include cardiac arrhythmias, aortic stenosis, and convulsive disorders alongside vertebrobasilar insufficiency.