Document Detail


Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis.
MedLine Citation:
PMID:  22206680     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Atherosclerotic occlusive disease of the proximal vertebral artery is an important cause of cerebrovascular ischemic events with a significant associated morbidity and mortality. Endovascular treatment has emerged as a promising tool of the therapeutic armamentarium, along with medical therapy and surgical reconstruction. Our objective was to systemically review the pertinent evidence on the endovascular management of proximal vertebral artery disease and perform an analysis of the published outcomes.
METHODS: A systematic review of the literature identified all studies reporting percutaneous transluminal angioplasty or stenting, or both, for proximal vertebral artery stenosis. Web-based search engines were searched using the Medical Subject Headings terms "vertebral artery," "angioplasty," and "stents" in all possible combinations. Studies comprising a series of at least five patients were considered for analysis. Periprocedural transient ischemic attack and stroke and death from any cause ≤30 days of treatment were defined as the primary outcome end points.
RESULTS: One randomized controlled trial comparing angioplasty and stenting of the proximal vertebral artery and medical therapy was identified. No comparative studies of endovascular treatment and open surgical repair were found. Forty-two selected studies reported endovascular treatment (angioplasty or stenting, or both) of 1117 vertebral arteries in 1099 patients. The weighted mean technical success rate was 97% (range, 36%-100%). Periprocedural transient ischemic attack occurred in 17 patients (1.5%). The combined stroke and death rate was 1.1%. Recurrent symptoms of vertebrobasilar insufficiency developed in 65 of 967 patients (8%) within a reported follow-up of 6 to 54 months. Restenosis developed in 183 of 789 patients (23%) who underwent follow-up imaging (range, 0%-58%). Reintervention for recurrent disease during follow-up occurred in 86 patients (9%; range, 0%-35%).
CONCLUSIONS: There is limited comparative evidence on the efficacy of medical, surgical, and endovascular treatment of proximal vertebral artery disease. Percutaneous transluminal angioplasty and stenting has low periprocedural neurologic adverse events and mortality.
Authors:
George A Antoniou; David Murray; George S Georgiadis; Stavros A Antoniou; Andrew Schiro; Ferdinand Serracino-Inglott; J Vincent Smyth
Publication Detail:
Type:  Journal Article; Review     Date:  2011-12-28
Journal Detail:
Title:  Journal of vascular surgery     Volume:  55     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-02     Completed Date:  2012-05-30     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1167-77     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. All rights reserved.
Affiliation:
Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom. antoniou.ga@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Angiography / methods
Angioplasty / methods*,  mortality
Case-Control Studies
Female
Follow-Up Studies
Great Britain
Hospital Mortality / trends
Humans
Male
Randomized Controlled Trials as Topic
Recurrence
Risk Assessment
Safety Management
Severity of Illness Index
Stents*
Survival Analysis
Treatment Outcome
Vertebrobasilar Insufficiency / mortality,  radiography,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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