Abstract
Introduction
We report our experience with the endovascular treatment of the vertebral artery origin in patients presenting with symptomatic vertebrobasilar ischemia and compare our results with those reported in the literature.
Methods
In 25 patients, 28 procedures were performed. Patients presented with posterior circulation ischemic symptoms despite optimal medical therapy with antiplatelet drugs and had a digital subtraction angiogram demonstrating stenosis of the origin of the vertebral artery greater than 50%. Retrospective review of the medical records, clinical notes and radiologic-procedural reports was performed.
Results
Of the 25 patients, 18 were male and 7 female. Their ages ranged from 50 to 84 years. In 23 of the 25 patients the contralateral vertebral artery was occluded, hypoplastic, absent, or had greater than 50% stenosis. In 13 of the 25 patients angiographic evidence of significant anterior circulation disease was demonstrated. In 18 of the 25 patients the left vertebral artery was affected. The mean stenosis was 82.6%. Follow-up records were available in 19 patients. The mean follow-up was 24 months. Five of the 19 patients had recurrent symptoms of vertebrobasilar ischemia and three patients were retreated. Of the 28 procedures performed, 23 were angioplasty/stenting and 5 were angioplasties alone. Overall technical success was achieved in 26 of the 28 procedures (92.8%). No procedure-related transient ischemic attack, stroke or death was noted.
Conclusion
Endovascular treatment of the vertebral artery origin in this patient population is feasible, safe, and effective. There are some questions regarding the long-term follow-up and rate of restenosis and clinical recurrences that are yet to be answered.
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References
Moufarrij NA, Little JR, Furlan AJ, et al (1984) Vertebral artery stenosis: long-term follow-up. Stroke 15:260–263
Wityk RJ, Chang HM, Rosengart A, et al (1998) Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 55:470–478
Caplan LR, Wityk RJ, Glass TA, et al (2004) New England Medical Center Posterior Circulation Registry. Ann Neurol 56:389–398
Albuquerque FC, Fiorella D, Han P, et al (2003) A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery 53:607–614
Chastain HD 2nd, Campbell MS, Iyer S, et al (1999) Extracranial vertebral artery stent placement: in-hospital and follow-up results. J Neurosurg 91:547–552
Weber W, Mayer TE, Henkes H, et al (2005) Efficacy of stent angioplasty for symptomatic stenoses of the proximal vertebral artery. Eur J Radiol 56:240–247
Henry M, Henry I, Klonaris C, et al (2003) Percutaneous transluminal angioplasty and stenting of extracranial vertebral artery stenosis. In: Henry M, Ohki T, Polydorou A, et al (eds) Angioplasty and stenting of the carotid and supra-aortic trunks, 1st edn. Taylor and Francis Medicine, UK, pp 673–682
Cloud GC, Crawley F, Clifton A, et al (2003) Vertebral artery origin angioplasty and primary stenting: safety and restenosis rates in a prospective series. J Neurol Neurosurg Psychiatry 74:586–590
Amin-Hanjani S, Du X, Zhao M, et al (2005) Use of quantitative magnetic resonance angiography to stratify stroke risk in symptomatic vertebrobasilar disease. Stroke 36:1140–1145
Malek AM, Higashida RT, Phatouros CC, et al (1999) Treatment of posterior circulation ischemia with extracranial percutaneous balloon angioplasty and stent placement. Stroke 30:2073–2085
Wehman JC, Hanel RA, Guidot CA, et al (2004) Atherosclerotic occlusive extracranial vertebral artery disease: indications for intervention, endovascular techniques, short-term and long-term results. J Interv Cardiol 17:219–322
Hauth EA, Gissler HM, Drescher R, et al (2004) Angioplasty or stenting of extra- and intracranial vertebral artery stenoses. Cardiovasc Intervent Radiol 7:51–57
Jenkins JS, White CJ, Ramee SR, et al (2001) Vertebral artery stenting. Catheter Cardiovasc Interv 54:1–5
Piotin M, Spelle L, Martin JB, et al (2000) Percutaneous transluminal angioplasty and stenting of the proximal vertebral artery for symptomatic stenosis. AJNR Am J Neuroradiol 21:727–731
Hayashi K, Kitagawa N, Morikawa M, et al (2003) A case of intimal hyperplasia induced by stenting for vertebral artery origin stenosis: assessed on intravascular ultrasound. Neurol Res 25:357–360
Fessler RD, Wakhloo AK, Lanzino G, et al (2000) Transradial approach for vertebral artery stenting: technical case report. Neurosurgery 46:1524–1527
Higashida RT, Tsai FY, Halbach VV, et al (1993) Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries. J Neurosurg 78:192–198
Bruckmann H, Ringelstein EB, Buchner H, et al (1986) Percutaneous transluminal angioplasty of the vertebral artery. A therapeutic alternative to operative reconstruction of proximal vertebral artery stenoses. J Neurol 233:336–339
Hass WK, Fields WS, North RR, et al (1968) Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. JAMA 203:961–968
Imparato AM (1985) Vertebral arterial reconstruction: a nineteen-year experience. J Vasc Surg 2:626–634
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Dabus, G., Gerstle, R.J., Derdeyn, C.P. et al. Endovascular treatment of the vertebral artery origin in patients with symptoms of vertebrobasilar ischemia. Neuroradiology 48, 917–923 (2006). https://doi.org/10.1007/s00234-006-0151-7
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DOI: https://doi.org/10.1007/s00234-006-0151-7