Percutaneous intervention for posterior fossa ischemia. A single center experience and review of the literature

Zavala-Alarcon, Edgardo; Emmans, Lisa; Little, Renee; Bant, Ankur

doi:10.1016/j.ijcard.2007.05.006

Cited by 15 publications

(13 citation statements)

References 38 publications

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“…1). Previously, periprocedural complication rates of 0–10.3% were reported for stent‐PTA in case series of 2–58 VAOS patients [16–27]. The periprocedural complication rate of 3.5% in our VAOS patients compares also favorably to results of extracranial intervention in the anterior circulation.…”

Section: Discussionsupporting

confidence: 63%

“…Therefore, research into alternative options for lowering stroke recurrence from stenoses in the vertebrobasilar circulation is badly needed. Both balloonmounted and self-expanding stents have been applied in intracranial vertebrobasilar atheromatous disease [5][6][7][8][9][10][11][12][13][14][15], and balloon-mounted stents have also been used for the treatment of vertebral artery origin stenosis (VAOS) [16][17][18][19][20][21][22][23][24][25][26][27]. However, available studies have not directly addressed differences between extra-and intracranial disease.…”

Section: Introductionmentioning

confidence: 99%

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Symptomatic stenosis of the vertebrobasilar arteries: results of extra‐ and intracranial stent‐PTA

Seifert¹,

Augustin

Klein

et al. 2008

Euro J of Neurology

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Symptomatic stenosis of the vertebrobasilar arteries: results of extra‐ and intracranial stent‐PTA

Seifert¹,

Augustin

Klein

et al. 2008

Euro J of Neurology

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“…2 Patients with symptomatic severe (Ͼ 70%) ostial VA stenosis face an 11% annual risk for recurrent stroke or TIA while receiving medical treatment.…”

Section: Abbreviationsmentioning

confidence: 99%

Recanalization of Symptomatic Vertebral Ostial Occlusion in Patients with Acute or Subacute Stroke

Park

Lee

Shim

et al. 2013

American Journal of Neuroradiology

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SUMMARY:Vertebral artery recanalization in symptomatic stenosis/occlusion remains controversial, as no definite evidence exists regarding this topic. There are only a few reports regarding the feasibility and safety of recanalization in the first segment of the vertebral artery with atherosclerotic vertebral ostial occlusion. We report our experience treating first segment occlusion in 8 patients and present a balloon protection technique used to reduce the thromboembolic burden during the stent placement procedure. The outcome at 3 months showed an mRS Յ2 except for a patient with a poor initial status with basilar artery occlusion. Revascularization of a rather long first segment occlusion is technically feasible and can be safely performed by use of embolic protection methods. A therosclerotic lesions of the vertebral artery (VA) origin are a potential cause of posterior circulation ischemia, which has approximately a 20% to 50% risk for vertebrobasilar TIA or stroke. ABBREVIATIONS:1 The VA ostium is known to be the most common site for atherosclerosis of the posterior circulation. 2 Patients with symptomatic severe (Ͼ 70%) ostial VA stenosis face an 11% annual risk for recurrent stroke or TIA while receiving medical treatment. 3Early understanding of the stroke mechanism of VA ostial lesions was focused on their hemodynamic nature, which commonly presents with TIA including dizziness.4 After a few case series that described an embolic infarct originating from vertebral ostial occlusive disease, 5 artery-to-artery embolism was also considered as an important cause of the stroke mechanism in lesions in the first segment of the VA (V1). 6 A large series of patients revealed that half of the artery-to-artery embolic strokes in the posterior circulation were the result of VA ostial lesions. 7 The presence of a clot in the vertebral ostial plaque provides the causeand-effect relationship between vertebral arterial ostial lesions and posterior circulation stroke. 8 Even a large ulcer in the vertebral arterial ostium has been described as adding to the possibility of the vertebral arterial ostium as a source of emboli. 9The optimal treatment of patients with symptomatic severe ostial VA stenosis is still unclear.3 The only randomized trial comparing endovascular with medical treatment is the Carotid and VA Transluminal Angioplasty Study. 10 This study did not show a separate result for the small number of its patients (nϭ16) with VA stenosis, though it failed to demonstrate the benefit of angioplasty of carotid and vertebral stenosis. Although several articles have dealt with revascularization of vertebral ostial lesions, they mostly have described revascularization of vertebral arterial stenosis.11 To our knowledge, only a few case reports have demonstrated anecdotal evidence of revascularization for vertebral ostial occlusion. 12 Therefore, we present the revascularization procedure and the outcome of vertebral ostial occlusion in strokes related to artery-to-artery embolism. MATERIALS AND METHODS Case SeriesEight...

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“…The development of successful vertebral artery intervention in the trauma setting 5,6,10 means it may now be technically feasible to treat VAI if this is shown to improve patient outcome, such as decreasing the risk of subsequent posterior circulation stroke.…”

Section: Introductionmentioning

confidence: 99%

Posterior circulation infarction in patients with traumatic cervical spinal cord injury and its relationship to vertebral artery injury

et al. 2014

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Study design: Prospective study. Objective: To ascertain the prevalence of posterior circulation stroke in traumatic chronic spinal cord injured (SCI) patients and associated traumatic vertebral artery injuries (VAI). Methods: All adult patients with cervical SCI and American Spinal Injury Association Impairment Scale (AIS) grade A or B referred for follow-up magnetic resonance imaging of their spinal cord were invited to take part in the study between January 2010 and December 2012 at the National Spinal Injury Centre. Two additional sequences were added to the existing imaging protocol to evaluate the brain and vertebral arteries. Results: Ninety-eight patients were recruited. All imaging were analysed independently by three consultant radiologists. Posterior circulation infarcts were noted in seven (7%) patients. Significant VAI was noted in 13 patients (13%) with 10 occlusions and 3 with high-grade stenosis. However, only one patient had co-existent posterior circulation infarct and significant VAI. Conclusion: There is an increased prevalence of posterior circulation infarction in SCI patients. The relationship with associated traumatic VAI requires further investigation.

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Percutaneous intervention for posterior fossa ischemia. A single center experience and review of the literature

Cited by 15 publications

References 38 publications

Symptomatic stenosis of the vertebrobasilar arteries: results of extra‐ and intracranial stent‐PTA

Symptomatic stenosis of the vertebrobasilar arteries: results of extra‐ and intracranial stent‐PTA

Recanalization of Symptomatic Vertebral Ostial Occlusion in Patients with Acute or Subacute Stroke

Posterior circulation infarction in patients with traumatic cervical spinal cord injury and its relationship to vertebral artery injury

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