Review of Outcomes Supports Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

July 25, 2011—Aaron N. Stayman, MD, et al have published findings from a systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis (ECVAS) in Stroke (2011;42:2212–2216).

The investigators found that the procedure had a low rate of periprocedural stroke or transient ischemic attack and showed that restenosis rates may not be as high as suspected. Given the frequency of ECVAS as an etiology for ischemic stroke, future studies aimed at determining efficacy of this treatment modality relative to medical therapy would be of benefit to clinicians caring for these patients, the investigators concluded.

According to the investigators, ECVAS is common among patients with ischemic stroke. Despite the limited knowledge of the natural history of patients with symptomatic vertebral disease, endovascular revascularization techniques are now used in clinical practice. Therefore, the investigators sought to determine the risk of endovascular treatment for ECVAS with a systematic review of the literature.

As detailed in Stroke, the investigators conducted a search through MEDLINE using the terms stenting, vertebral, ostium, origin, and extracranial. All articles were reviewed along with their references to determine the risk and durability of endovascular treatment. The investigators identified 27 articles that met inclusion criterion, with a total of 980 of 993 patients treated with stents. The majority of patients (56%) were noted to have contralateral vertebral artery stenosis or occlusion, and 92% were symptomatic at the time of treatment. Eleven patients (1.1%) experienced a stroke, and eight patients (0.8%) experienced a transient ischemic attack within 30 days of the procedure. Drug-eluting stents were associated with lower restenosis rates (11%) compared to bare-metal stents (30%) at a mean of 24 months of follow-up, the investigators reported in Stroke.