Skip to main content
SpringerLink
Log in

The Approach to Intracranial and Extracranial Vertebral Artery Stenting

  • Chapter
Handbook Of Complex Percutaneous Carotid Intervention

Part of the book series: Contemporary Cardiology ((CONCARD))

  • 874 Accesses

Abstract

Approximately 25% of ischemic strokes involve the posterior or vertebrobasilar circulation, which is associated with a mortality of 20-30%. Posterior circulation strokes are predominantly due to embolism and large artery disease. This chapter focuses on the percutaneous management of patients with significant atherosclerotic stenosis of the extracranial and intracranial vertebral artery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Patrick BK, Ramirez-Lassepas M, Synder BD. Temporal profile of vertebrobasilar territory infarction. Prognostic implications. Stroke 1980; 11:643–648.

    PubMed  CAS  Google Scholar 

  2. Caplan L. Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000.Stroke 2000;31:2011–2023.

    PubMed  CAS  Google Scholar 

  3. Caplan LR, Wityk RJ, Glass TA, et al. New England Medical Center Posterior Circulation registry. Ann Neurol 2004;56:389–398.

    Article  PubMed  Google Scholar 

  4. Wityk RJ, Chang HM, Rosengart A, et al. Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 1998;55:470–478.

    Article  PubMed  CAS  Google Scholar 

  5. Cartlidge NE, Whisnant JP, Elveback LR. Carotid and vertebral-basilar transient cerebral ischemic attacks. A community study, Rochester, Minnesota. Mayo Clin Proc 1977;52:117–120.

    PubMed  CAS  Google Scholar 

  6. Whisnant JP, Cartlidge NE, Elveback LR. Carotid and vertebral-basilar transient ischemic attacks: effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence-a population study. Ann Neurol 1978;3:107–115.

    Article  PubMed  CAS  Google Scholar 

  7. Lemke AJ, Benndorf G, Liebig T, Felix R.Anomalous origin of the right vertebral artery: review of the literature and case report of right vertebral artery origin distal to the left subclavian artery. AJNR Am J Neuroradiol 1999;20:1318–1321.

    PubMed  CAS  Google Scholar 

  8. Gluncic V, Ivkic G, Marin D, Percac S. Anomalous origin of both vertebral arteries. Clin Anat 1999;12:281–284.

    Article  PubMed  CAS  Google Scholar 

  9. Palmer FJ. Origin of the right vertebral artery from the right common carotid artery: angiographic demonstration of three cases. Br J Radiol 1977;50:185–187.

    PubMed  CAS  Google Scholar 

  10. Shrontz C, Dujovny M, Ausman JI, et al. Surgical anatomy of the arteries of the posterior fossa. J Neurosurg 1986;65:540–544.

    PubMed  CAS  Google Scholar 

  11. Wollschlaeger G, Wollschlaeger PB, Lucas FV, Lopez VF. Experience and result with postmortem cerebral angiography performed as routine procedure of the autopsy. Am J Roentgenol Radium Ther NuclMed 1967;101:68–87.

    CAS  Google Scholar 

  12. Baskaya M, Coscarella E, Gomez F, Morcos J. Surgical and angiographic anatomy of the posterior communicating and anterior choroidal arteries. Neuroanatomy 2004;3:38–42.

    Google Scholar 

  13. Bisaria KK. Anomalies of the posterior communicating artery and their potential clinical significance. J Neurosurg 1984;60:572–576.

    PubMed  CAS  Google Scholar 

  14. Wells CE. The cerebral circulation. The clinical significance of current concepts. Arch Neurol 1960;3:319–331.

    PubMed  CAS  Google Scholar 

  15. Schomer DF, Marks MP, Steinberg GK, et al. The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction. N Engl J Med 1994;330:1565–1570.

    Article  PubMed  CAS  Google Scholar 

  16. Ackerstaff RG, Hoeneveld H, Slowikowski JM, Moll FL, Eikelboom BC, Ludwig JW. Ultrasonic duplex scanning in atherosclerotic disease of the innominate, subclavian and vertebral arteries. A comparative study with angiography. Ultrasound Med Biol 1984;10:409–418.

    Article  PubMed  CAS  Google Scholar 

  17. de Bray JM, Pasco A, Tranquart F, et al. Accuracy of color-Doppler in the quantification of proximal vertebral artery stenoses. Cerebrovasc Dis 2001;11:335–340.

    Article  PubMed  Google Scholar 

  18. Cloud GC, Markus HS. Vertebral artery stenosis. Curr Treat Options Cardiovasc Med 2004;6: 121–127.

    Article  PubMed  Google Scholar 

  19. Kuhl V, Tettenborn B, Eicke BM, Visbeck A, Meckes S. Color-coded duplex ultrasonography of the origin of the vertebral artery: normal values of flow velocities. J Neuroimaging 2000; 10:17–21.

    PubMed  CAS  Google Scholar 

  20. Cloud GC, Markus HS. Diagnosis and management of vertebral artery stenosis. Qjm 2003;96:27–54.

    Article  PubMed  CAS  Google Scholar 

  21. Clifton AG. MR angiography. Br Med Bull 2000;56:367–377.

    Article  PubMed  CAS  Google Scholar 

  22. Randoux B, Marro B, Koskas F, Chiras J, Dormont D, Marsault C. Proximal great vessels of aortic arch: comparison of three-dimensional gadolinium-enhanced MR angiography and digital subtraction angiography. Radiology 2003;229:697–702.

    Article  PubMed  Google Scholar 

  23. Bhadelia RA, Bengoa F, Gesner L, et al. Efficacy of MR angiography in the detection and characterization of occlusive disease in the vertebrobasilar system. J Comput Assist Tomogr 2001;25:458–465.

    Article  PubMed  CAS  Google Scholar 

  24. Graf J, Skutta B, Kuhn FP, Ferbert A. Computed tomographic angiography findings in 103 patients following vascular events in the posterior circulation: potential and clinical relevance. J Neurol 2000;247:760–766.

    Article  PubMed  CAS  Google Scholar 

  25. Fayed AM, White CJ, Ramee SR, Jenkins JS, Collins TJ. Carotid and cerebral angiography performed by cardiologists: cerebrovascular complications. Catheter Cardiovasc Interv 2002;55:277–280.

    Article  PubMed  Google Scholar 

  26. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005;352:1305–1316.

    Article  PubMed  CAS  Google Scholar 

  27. Carney AL, Anderson EM, Martinez DM. Advances in vertebral artery surgery at the skull base. Tex Heart Inst J 1986;13:83–90.

    PubMed  CAS  Google Scholar 

  28. Berguer R, Flynn LM, Kline RA, Caplan L.Surgical reconstruction of the extracranial vertebral artery: management and outcome. J Vasc Surg 2000;31:9–18.

    Article  PubMed  CAS  Google Scholar 

  29. Chastain HD, 2nd, Campbell MS, Iyer S, et al. Extracranial vertebral artery stent placement: in-hospital and follow-up results. J Neurosurg 1999;91:547–552.

    PubMed  Google Scholar 

  30. Albuquerque FC, Fiorella D, Han P, Spetzler RF, McDougall CG. A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery 2003;53:607–614; discussion 614-616.

    Article  PubMed  Google Scholar 

  31. Jenkins JS, White CJ, Ramee SR, et al. Vertebral artery stenting. Catheter Cardiovasc Interv 2001;54:1–5.

    CAS  Google Scholar 

  32. Hankey GJ, Coward LJ, Featherstone RL, Brown MM. Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis. Stroke 2005;36:2047–2048.

    Article  Google Scholar 

  33. Crawley F, Brown MM, Clifton AG. Angioplasty and stenting in the carotid and vertebral arteries. Postgrad Med J 1998;74:7–10.

    Article  PubMed  CAS  Google Scholar 

  34. Storey GS, Marks MP, Dake M, Norbash AM, Steinberg GK. Vertebral artery stenting following percutaneous transluminal angioplasty. Technical note. J Neurosurg 1996;84:883–887.

    PubMed  CAS  Google Scholar 

  35. Higashida RT, Furlan AJ, Roberts H, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003;34:e109–e137.

    Article  PubMed  Google Scholar 

  36. Lin DD, Gailloud P, Beauchamp NJ, Aldrich EM, Wityk RJ, Murphy KJ. Combined stent placement and thrombolysis in acute vertebrobasilar ischemic stroke. AJNR Am J Neuroradiol 2003;24: 1827–1833.

    PubMed  Google Scholar 

  37. Nomura M, Hashimoto N, Nishi S, Akiyama Y. Percutaneous transluminal angioplasty for intracranial vertebral and/or basilar artery stenosis. Clin Radiol 1999;54:521–527.

    Article  PubMed  CAS  Google Scholar 

  38. Deshmukh VR, Fiorella DJ, Albuquerque FC, et al. Intra-arterial thrombolysis for acute ischemic stroke: preliminary experience with platelet glycoprotein IIb/IIIa inhibitors as adjunctive therapy. Neurosurgery 2005;56:46–54; discussion 54-55.

    Article  PubMed  Google Scholar 

  39. Barakate MS, Snook KL, Harrington TJ, Sorby W, Pik J, Morgan MK. Angioplasty and stenting in the posterior cerebral circulation. J Endovasc Ther 2001;8:558–565.

    Article  PubMed  CAS  Google Scholar 

  40. Wehman JC, Hanel RA, Guidot CA, Guterman LR, Hopkins LN. Atherosclerotic occlusive extracranial vertebral artery disease: indications for intervention, endovascular techniques, short-term and long-term results. J Interv Cardiol 2004;17:219–232.

    Article  PubMed  Google Scholar 

  41. Bhatt DL, Kapadia SR, Bajzer CT, et al. Dual antiplatelet therapy with clopidogrel and aspirin after carotid artery stenting. J Invasive Cardiol 2001;13:767–771.

    PubMed  CAS  Google Scholar 

  42. Fessler RD, Wakhloo AK, Lanzino G, Guterman LR, Hopkins LN. Transradial approach for vertebral artery stenting: technical case report. Neurosurgery 2000;46:1524–1527; discussion 1527-1528.

    Article  PubMed  CAS  Google Scholar 

  43. Bendok BR, Przybylo JH, Parkinson R, Hu Y, Awad IA, Batjer HH. Neuroendovascular interventions for intracranial posterior circulation disease via the transradial approach: technical case report. Neurosurgery 2005;56:E626; discussion E626.

    Article  PubMed  Google Scholar 

  44. Abou-Chebl A, Bashir Q, Yadav JS. Drug-eluting stents for the treatment of intracranial atherosclerosis: initial experience and midterm angiographic follow-up. Stroke 2005;36:e165–e168.

    Article  PubMed  CAS  Google Scholar 

  45. Mintz EP, Gruberg L, Kouperberg E, Beyar R. Vertebral artery stenting using distal emboli protection and transcranial Doppler. Catheter Cardiovasc Interv 2004;61:12–15.

    Article  PubMed  Google Scholar 

  46. Ringelstein EB, Zeumer H. Delayed reversal of vertebral artery blood flow following percutaneous transluminal angioplasty for subclavian steal syndrome. Neuroradiology 1984;26:189–198.

    Article  PubMed  CAS  Google Scholar 

  47. Sawada M, Hashimoto N, Nishi S, Akiyama Y. Detection of embolic signals during and after percutaneous transluminal angioplasty of subclavian and vertebral arteries using transcranial Doppler ultra-sonography. Neurosurgery 1997;41:535–540; discussion 540-541.

    Article  PubMed  CAS  Google Scholar 

  48. Wiviott SD, Antman EM. Clopidogrel resistance: a new chapter in a fast-moving story. Circulation 2004;109:3064–3067.

    Article  PubMed  Google Scholar 

  49. Cloud GC, Crawley F, Clifton A, McCabe DJ, Brown MM, Markus HS. Vertebral artery origin angio-plasty and primary stenting: safety and restenosis rates in a prospective series. J Neurol Neurosurg Psychiatry 2003;74:586–590.

    Article  PubMed  CAS  Google Scholar 

  50. Levy EI, Hanel RA, Howington JU, et al. Sirolimus-eluting stents in the canine cerebral vasculature: a prospective, randomized, blinded assessment of safety and vessel response. J Neurosurg 2004;100:688–694.

    PubMed  CAS  Google Scholar 

  51. Rezende MT, Spelle L, Mounayer C, Piotin M, Abud DG, Moret J. Hyperperfusion syndrome after stenting for intracranial vertebral stenosis. Stroke 2006;37:e12–e14.

    Article  PubMed  Google Scholar 

  52. Steinhubl SR, Berger PB, Mann JT, 3rd, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. Jama 2002;288:2411–2420.

    Article  PubMed  CAS  Google Scholar 

  53. Nissen SE. Effect of intensive lipid lowering on progression of coronary atherosclerosis: evidence foran early benefit from the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL)trial. Am J Cardiol 2005;96:61F–68F.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. J. Emilio Exaire MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacqueline Saw MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Cardiology, University of British Columbia, Vancouver, BC, Canada

    Jacqueline Saw MD

  2. Department of Interventional Cardiology, Instituto Nacional de Cardiología “Ignacio Chávez,”, Mexico City, Mexico

    J. Emilio Exaire MD

  3. Interventional Cardiology, Hillsboro Cardiology, Hillsboro, OR

    David S. Lee MD

  4. Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH

    Jay S. Yadav MD

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Exaire, J.E., Saw, J. (2007). The Approach to Intracranial and Extracranial Vertebral Artery Stenting. In: Saw, J., Exaire, J.E., Lee, D.S., Yadav, J.S. (eds) Handbook Of Complex Percutaneous Carotid Intervention. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-002-7_14

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-002-7_14

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-605-4

  • Online ISBN: 978-1-59745-002-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation