Purpose: Two of three patients with vertebrobasilar stroke harbor a stenosis of the vertebral or basilar arteries. The best treatment for secondary prophylaxis in vertebrobasilar occlusive disease has not been defined. In patients with high-grade stenoses, and especially those refractory to medication, stenting offers the chance to restore normal flow and prevent major strokes.
Methods: We provide data regarding outcome and complications on 20 consecutive patients who underwent vertebrobasilar stenting at our institution (9 V0, 2V3, 5 V4, and 4 basilar artery lesions). Furthermore, we provide a comprehensive overview of the literature on >600 cases of vertebrobasilar stenting, including all published cases up to 2005.
Results: Primary interventional success was achieved in all cases, with a mean residual stenosis of 3% +/- 4% in V0, 5% +/- 4% in V3/4, and 7% +/- 3% in basilar artery lesions. No peri-interventional neurologic complications and no transient ischemic attack or stroke at follow-up were noted in patients with vertebral ostial lesions, whereas two transient and three permanent clinical deteriorations occurred in patients with V4 or basilar artery lesions, some of which had presented with acute stroke. Patency rate was 100% at the last examination. According to published data on proximal vertebral artery stenting, mortality is 0.3%, the rate of neurologic complications is 5.5%, and the risk of posterior stroke at follow-up is 0.7%. Interventions for distal vertebral or basilar artery disease carry a 3.2% mortality risk, a 17.3% risk for neurologic complications and a 2% risk for stroke at follow-up.
Conclusions: Stenting of the vertebral origin can be performed safely and with a low rate of cerebral ischemic events at follow-up, although restenosis may occur. Larger comparative trials are needed. Treatment decisions in distal vertebrobasilar disease have been made on an individual basis.