Vertebral Artery Interventions: A Comprehensive Updated Review

Patients with posterior circulation ischemia due to vertebral artery stenosis account for 20 to 25% of ischemic strokes and have an increased risk of recurrent stroke. In patients treated with medical therapy alone, the risk of recurrence is particularly increased in the first few weeks after sympto...

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Bibliographic Details
Published in:Current cardiology reviews 2023, Vol.19 (1), p.e170322202296-e170322202296
Main Authors: Maitas, Oscar, Bob-Manuel, Tamunoinemi, Price, Justin, Noor, Abdullah, Obi, Koyenum, Okoh, Nelson, Garikapati, Kiran, Kim, Jeong, Jahan, Sanjida, Jenkins, James S
Format: Article
Language:English
Subjects:
Angioplasty
Angioplasty - adverse effects
Angioplasty - methods
Cardiovascular system
Clinical trials
Health risks
Health services
Humans
Ischemia
Medical treatment
Medicine, Cardiology
Morbidity
Mortality
Patients
Percutaneous treatment
Risk
Signs and symptoms
Stenosis
Stents
Stroke
Stroke - etiology
Stroke - therapy
Therapy
Treatment Outcome
Vertebrae
Vertebral Artery - diagnostic imaging
Vertebrobasilar Insufficiency - complications
Vertebrobasilar Insufficiency - diagnosis
Vertebrobasilar Insufficiency - therapy
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Summary:Patients with posterior circulation ischemia due to vertebral artery stenosis account for 20 to 25% of ischemic strokes and have an increased risk of recurrent stroke. In patients treated with medical therapy alone, the risk of recurrence is particularly increased in the first few weeks after symptoms occur, with an annual stroke rate of 10 to 15%. Additionally, obstructive disease of the vertebrobasilar system carries a worse prognosis, with a 30% mortality at 2-years if managed medically without additional surgical or endovascular intervention. Percutaneous transluminal angioplasty and stenting of symptomatic vertebral artery stenosis are promising options widely used in clinical practice with good technical results; however, the improved clinical outcome has been examined in various clinical trials without a sufficient sample size to conclusively determine whether stenting is better than medical therapy. Surgical revascularization is an alternative approach for the treatment of symptomatic vertebral artery stenosis that carries a 10-20% mortality rate. Despite the advances in medical therapy and endovascular and surgical options, symptomatic vertebral artery stenosis continues to impose a high risk of stroke recurrence with associated high morbidity and mortality. This review aims to provide a focused update on the percutaneous treatment of vertebral artery stenosis, its appropriate diagnostic approach, and advances in medical therapies.
ISSN:1573-403X
1875-6557
DOI:10.2174/1573403X18666220317093131