Endovascular Management of Vertebral Artery Disease
Endovascular Management of Vertebral Artery Disease
Symptomatic disease of the vertebrobasilar circulation is often underdiagnosed and undertreated. In recent years, endovascular revascularization of vertebral artery stenosis has been heralded as a less invasive treatment option in comparison to open surgery, with the inherent risk of morbidity. Although a growing number of case reports and small nonrandomized case series suggest that endovascular intervention in the posterior circulation may be safe and technically feasible, the safety and benefit of angioplasty and stent placement in cases of symptomatic vertebral disease, as compared with the most effective medical therapy, remains to be elucidated.
Ischemia of the posterior circulation related to atherosclerotic vertebral artery disease is less common and often underdiagnosed in comparison to pathologies involving the anterior circulation. Patients with vertebrobasilar ischemia, however, represent a significant cohort of patients with ischemic symptoms, as approximately 25% of all transient ischemic attacks and ischemic strokes involve areas of the brain supplied by the vertebrobasilar circulation. Associated symptoms such as dizziness, ataxia, visual disturbances and motor–sensory deficits, might be dismissed as nonspecific findings. As such, clinicians may be reluctant to pursue definitive diagnosis or recommend treatment for potentially correctable lesions that may be responsible for these symptoms. For patients who experience vertebrobasilar transient ischemic attacks, disease identified in the vertebral arteries portends a 30–35% risk for stroke over a 5-year period. Medical refractory disease of the vertebrobasilar system carries a 5–11% risk of stroke or death at 1 year. Consequently, mortality associated with a posterior circulation stroke can be high, ranging from 20 to 30%.
Abstract and Introduction
Abstract
Symptomatic disease of the vertebrobasilar circulation is often underdiagnosed and undertreated. In recent years, endovascular revascularization of vertebral artery stenosis has been heralded as a less invasive treatment option in comparison to open surgery, with the inherent risk of morbidity. Although a growing number of case reports and small nonrandomized case series suggest that endovascular intervention in the posterior circulation may be safe and technically feasible, the safety and benefit of angioplasty and stent placement in cases of symptomatic vertebral disease, as compared with the most effective medical therapy, remains to be elucidated.
Introduction
Ischemia of the posterior circulation related to atherosclerotic vertebral artery disease is less common and often underdiagnosed in comparison to pathologies involving the anterior circulation. Patients with vertebrobasilar ischemia, however, represent a significant cohort of patients with ischemic symptoms, as approximately 25% of all transient ischemic attacks and ischemic strokes involve areas of the brain supplied by the vertebrobasilar circulation. Associated symptoms such as dizziness, ataxia, visual disturbances and motor–sensory deficits, might be dismissed as nonspecific findings. As such, clinicians may be reluctant to pursue definitive diagnosis or recommend treatment for potentially correctable lesions that may be responsible for these symptoms. For patients who experience vertebrobasilar transient ischemic attacks, disease identified in the vertebral arteries portends a 30–35% risk for stroke over a 5-year period. Medical refractory disease of the vertebrobasilar system carries a 5–11% risk of stroke or death at 1 year. Consequently, mortality associated with a posterior circulation stroke can be high, ranging from 20 to 30%.
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