Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: to treat or not to treat
Article first published online: 17 SEP 2009
© 2009 The Author(s). Journal compilation © 2009 EFNS
European Journal of Neurology
Volume 17, Issue 2, pages 267–272, February 2010
How to Cite
Parkhutik, V., Lago, A., Tembl, J.I., Aparici, F., Vazquez, V. and Mainar, E. (2010), Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: to treat or not to treat. European Journal of Neurology, 17: 267–272. doi: 10.1111/j.1468-1331.2009.02786.x
- Issue published online: 13 JAN 2010
- Article first published online: 17 SEP 2009
- Received 16 February 2009 Accepted 23 July 2009
- asymptomatic stenosis;
- posterior circulation stroke;
- vertebral angioplasty;
- vertebral symptomatic stenosis
Background and purpose: Comprehensive indications for treatment of symptomatic vertebral stenosis remain unavailable. Even less is known about endovascular treatment of asymptomatic cases. We treated symptomatic and asymptomatic vertebral ostium stenosis with angioplasty and stenting and investigated the long term outcome.
Methods: Consecutive patients with two different indications were included. Group 1 (G1) had symptomatic >50% stenosis. Group 2 (G2) had asymptomatic >50% stenosis and severe lesions of anterior circulation and were expected to benefit from additional cerebral blood supply.
Results: Twenty nine vertebral origin stenoses in 28 patients (75% men, mean age 64 ± 9 years) were treated. There were 16 G1 and 13 G2 cases. Technical success rate was 100%. Immediate neurological complications rate was 3.4% (one G1 patient with vertebral TIA due to release of emboli). Two further strokes were seen during follow up (32 ± 24 months): vertebrobasilar stroke in a G2 patient with permeable stent in V1 segment, new ipsilateral V3 occlusion and high-risk cardioembolic source, and carotid stroke in a G1 patient who had had ipsilateral carotid stenting. There were no deaths of any cause. Asymptomatic restenosis was observed in one out of 19 patients from both groups who underwent a follow up angiography.
Conclusions: Angioplasty and stenting appears to be technically feasible and safe in asymptomatic and symptomatic vertebral stenosis. More studies are needed in order to clarify its role in primary and secondary prevention of vertebrobasilar stroke. High risk anterior circulation lesions should be taken into account as a possible indication in patients with asymptomatic vertebral stenosis.