Document Detail

Endovascular treatment of supra-aortic extracranial stenoses in patients with vertebrobasilar insufficiency symptoms.
MedLine Citation:
PMID:  16718428     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Stenoses and thromboses of vessels feeding the vertebrobasilar territory can evoke serious disturbances including ischemic stroke. We present our experience of endovascular interventions for patients with signs of vertebrobasilar insufficiency (VBI) resulted from subclavian, vertebral and brachiocephalic arterial stenoses. METHODS: Twenty-one patients (10 men) aged from 35 to 84 years (mean 64.3 years) with symptoms compatible with VBI underwent balloon angioplasty and stenting of subclavian (SA), innominate (IA) and vertebral (VA) arteries. Procedures were done by radiologists experienced in systematic stenting of the lesions. VBI was manifested by persistent signs in 15 patients, and by transitory ischemic attacks in the posterior circulatory territory in 4 (19%). Two patients (10%) experienced ischemic strokes (in the vertebrobasilar circulation in both cases). In 3 patients (14%) VBI was accompanied by upper limb vascular insufficiency symptoms. All cases were resistant to medical treatment. A neurologist assessed complaints, initial VBI signs and their alteration after intervention in all patients. Outcomes were measured with the 5-point scale suggested by Malek et al.: (1) excellent result (asymptomatic, no neurologic deficits and no symptoms of vertebrobasilar ischemia); (2) good (no neurologic deficits, at most one transient episode of vertebrobasilar ischemia over a period of 3 months after treatment); (3) fair (minimal neurologic deficit and at most one transient episode per month of vertebrobasilar ischemia); (4) poor (no improvement compared with neurologic status before treatment and/or persistent symptoms of vertebrobasilar ischemia); (5) death (regardless of cause). Endovascular treatment was performed for SA stenosis in 15 patients, for SA occlusion in 2, for IA stenosis in 2, and for VA stenosis in 2. There were 15 cases of atherosclerosis, 2 of aortoarteritis, 4 of proximal SA kinking. SA and IA stenoses ranged from 60% to 100% (mean 74.5%), VA stenoses were 90% in both cases. RESULTS: Initial technical success was achieved in 96% of cases. There were no postprocedural complications or deaths. During 6-36 months (mean 21.3 months) of follow-up all patients showed improvement in VBI symptoms or upper limb ischemia. Within 36 months after the procedure outcomes were estimated as excellent and good in 13 patients (76%) and poor in 2 (12%), the last being attributed to atherosclerosis progression in other vascular areas. Restenosis in the stented area has developed in 1 patient (6%). CONCLUSIONS: Balloon angioplasty and stenting of extracranial vertebrobasilar arterial stenoses appeared to be effective in endovascular treatment of medically resistant VBI. Further investigations are required to clarify the role of subclavian artery kinking in VBI development and indications for various methods of its correction.
A Y Zaytsev; A Y Stoyda; V E Smirnov; A N Scherbyuk; S A Kondrashin; E G Artukchina; V A Kikevitch
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular and interventional radiology     Volume:  29     ISSN:  0174-1551     ISO Abbreviation:  Cardiovasc Intervent Radiol     Publication Date:    2006 Sep-Oct
Date Detail:
Created Date:  2006-07-26     Completed Date:  2006-12-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003538     Medline TA:  Cardiovasc Intervent Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  731-8     Citation Subset:  IM    
Department of Angiography and Interventional Radiology, I.M. Setchenov Moscow Medical Academy, 119881 Moscow, Russian Federation.
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MeSH Terms
Aged, 80 and over
Angiography, Digital Subtraction
Angioplasty, Balloon*
Arterial Occlusive Diseases / complications,  radiography,  therapy*
Brachiocephalic Trunk* / pathology,  radiography
Ischemic Attack, Transient / etiology
Middle Aged
Radiography, Interventional
Subclavian Artery* / pathology,  radiography
Vertebral Artery* / pathology,  radiography
Vertebrobasilar Insufficiency / etiology,  therapy*

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