A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

Background and Purpose— Extracranial vertebral artery stenosis (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 utilized in clinical practice. We sought to determine the risk of endovascular treatment for ECVAS with a systematic review of the literature. Methods— A search strategy was used using the terms “stenting,” “vertebral,” “ostium,” “origin,” and “extracranial” through Medline. All articles were reviewed along with their references to determine the risk and durability of endovascular treatment. Results— A total of 27 articles were identified 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. A total of 11 patients (1.1%) experienced a stroke and 8 (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. Conclusions— Stenting and angioplasty of ECVAS appear to have a low rate of periprocedural stroke or transient ischemic attack and restenosis rates that 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.