Benefits and risks of endovascular treatment in patients with proximal vertebral artery stenosis

Abstract

Extracranial vertebral artery stenosis is an important cause of posterior circulation ischemic stroke. There are several therapeutic approaches in patients with vertebral artery (VA) stenosis, including medical, endovascular and surgical treatment. This review should summarize the literature concerning endovascular treatment (EVT) of extracranial VA stenosis. By scanning reference lists of other review articles and by searching electronic database MEDLINE by using major MESH term "vertebrobasilar insufficiency/therapy" from January 2010 to April 2015, studies that included patients of any race, age and sex with symptomatic or asymptomatic atherosclerotic stenotic VA disease were identified. Periprocedural transitory ischemic attack (TIA) and stroke, and death within 30 days of the treatment were our primary interest and symptom resolution was secondary outcome measure. We found 12 retrospective studies with prospectively collected data and one additional comparative study of VA angioplasty/stenting and medical treatment was found. Percutaneous luminal angioplasty or stenting alone, or their combinations were performed in 693 patients (726 lesions). Periprocedural TIA or stroke occurred in 14 out of 693 patients (2.0%) and 30 days mortality in 1 (0.15%). A wide range of restenosis rates (3-58%) was reported. The literature shows that EVT of extracranial VA stenosis is safe and efficient. The vast majority of patients remain symptom free after the procedure, despite the restenosis rate.