Subclavian and Vertebral Artery Angioplasty - Vertebro-Basilar Insufficiency: Clinical Aspects and Diagnosis

BACKGROUND: Percutaneous transluminal angioplasty (PTA) for significant stenosis involving the origin of the vertebral artery is now a well established treatment for selected patients when posterior cerebral arterial circulation is compromised. We demonstrate from our short and long-term results, after transluminal treatment of subclavian and vertebral artery stenosis, the feasibility and safety of treatment with balloon angioplasty and stenting. PATIENTS AND METHODS: A total of 181 patients underwent endovascular treatment and were divided into two groups. In group A, we treated patients with chronic vertebrobasilar insufficient. In this group, 21 patients with severe vertebral artery stenosis had also concomitant severe stenosis in other supra aortic arteries. In group B we treated patients with subclavian steal syndrome. In this group 21 patients presented with coexistence of severe stenosis in other supra aortic arteries. Stent patency of subclavian and vertebral artery during follow up was assessed by duplex scan and physical examination, with comparison of brachial blood pressure of both arms especially in patients with subclavian stenosis. Digital angiography was performed in available patients. Cerebral oximetry and intracranial Doppler were used to determine the group of patients that we had to treat with balloon angioplasty and stenting. RESULTS: Successful stenting was achieved in all cases. There were no complications. The primary stenting patency during follow-up (mean 8.6 months) was 98.6%. With use of intracranial Doppler we found 31 patients with higher blood flow in the basilar artery after stenting and 24 patients were found with increased brain regional oxygen saturation in the anterior cerebral artery. CONCLUSION: Endovascular treatment of subclavian and vertebral arteries with balloon angioplasty and stenting was found to be necessary in certain cases and a less invasive alternative to surgical repair. Long-term results must still be confirmed in further studies