Vertebral artery stenosis

Madonis, Stephanie; Jenkins, J. Stephen

doi:10.1016/j.pcad.2021.02.006

Cited by 20 publications

(24 citation statements)

References 33 publications

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“…Current RCTs have not demonstrated that endovascular therapy has a significant advantage over medical therapy alone for VAS. 2 Significantly, the vertebral artery ischaemia stenting trial found that the stent group had a lower stroke rate during follow-up among patients who were randomized within 2 weeks of the last symptoms. 18 Although several non-RCT studies continue to demonstrate the efficacy and safety of stenting for symptomatic vertebral stenosis, the problem of ISR still needs further research.…”

Section: Discussionmentioning

confidence: 99%

“…Current RCTs have not demonstrated that endovascular therapy has a significant advantage over medical therapy alone for VAS 2 . Significantly, the vertebral artery ischaemia stenting trial found that the stent group had a lower stroke rate during follow‐up among patients who were randomized within 2 weeks of the last symptoms 18 .…”

Section: Discussionmentioning

confidence: 99%

“…DES reduces the risk of ISR by carrying antiproliferative agents to suppress neointimal hyperplasia and has achieved satisfactory results in the treatment of coronary arteries 26,27 . However, its ISR rates in vertebral arteries are not uniform, with the highest being 75% 2,9 . The results of Langwieser et al's 28 meta‐analysis showed that the ISR rate of BMS in the extracranial vertebral artery was significantly higher than that of DES ( p = 0.005), but DES was ≤6 cases in five of the nine included studies.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for in‐stent restenosis after vertebral artery stenting of V1 segment: A systematic review and meta‐analysis

Guo

Ning

Zhang

et al. 2022

Cathet Cardio Intervent

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Objective In‐stent restenosis (ISR) remains a challenge in the treatment of vertebral artery V1 segment stenosis. The aim of this meta‐analysis is to identify the risk factors of ISR. Methods Studies eligible for inclusion criteria were found in PubMed, Embase, and Cochrane Library databases. Data related to risk factors of ISR were extracted from the included studies, and pooled analysis was performed when data of the same factor were available in ≥2 studies. Dichotomous outcomes were analyzed with odds ratios (OR) and continuous outcomes were analyzed with a weighted mean difference (WMD). The Stata 14.0 program was used for the meta‐analysis. Results A total of 11 studies involving 1356 patients were included in our analysis. Pooled analyses showed that younger age (p = 0.01; WMD= −1.958; 95% confidence interval [CI], −3.453 to −0.463) and V1 tortuosity (p = 0.004; OR = 4.145; 95% CI, 1.56–11.012) significantly associated with higher risk of ISR in V1 segment stenting. While bare‐metal stents, stent diameter and length, diabetes mellitus, coronary artery disease, and smoking were not found to increase ISR rates. Conclusions This meta‐analysis showed that young age and V1 tortuosity increase the ISR rates after vertebral V1 segment stenting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk factors for in‐stent restenosis after vertebral artery stenting of V1 segment: A systematic review and meta‐analysis

Guo

Ning

Zhang

et al. 2022

Cathet Cardio Intervent

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“…It can be divided into four anatomically different segments (V1-V4), where segments V1-V3 are classified as the extracranial vertebral artery, and segment V4 is considered the intracranial vertebral artery [15]. The first segment (V1), known as the proximal or ostial segment, is defined from its origin of branching off the subclavian artery to the sixth cervical vertebrae's transverse foramen [4,16]. The second segment (V2), known as the transverse segment, is defined from the transverse foramina of the sixth cervical vertebrae to the transverse foramina of the second cervical vertebrae [4,16].…”

Section: Review Normal Anatomymentioning

confidence: 99%

“…The first segment (V1), known as the proximal or ostial segment, is defined from its origin of branching off the subclavian artery to the sixth cervical vertebrae's transverse foramen [4,16]. The second segment (V2), known as the transverse segment, is defined from the transverse foramina of the sixth cervical vertebrae to the transverse foramina of the second cervical vertebrae [4,16]. The third segment (V3), known as the suboccipital segment, is defined from where the artery leaves the transverse foramina of the second cervical vertebrae to where it pierces the dura mater at the level of the foramen magnum [4,16].…”

Section: Review Normal Anatomymentioning

confidence: 99%

Vertebral Artery Stenosis: A Narrative Review

Burle¹,

Panjwani²,

Mandalaneni³

et al. 2022

Cureus

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Vertebral artery stenosis (VAS) is the cause of approximately 20% of ischemic strokes in the posterior circulation. There are several causes of vertebral artery stenosis, including atherosclerosis, calcification, dissections, fibromuscular dysplasia, giant cell arteritis, neurofibromatosis type 1, and bony compressions. The most common cause of VAS is atherosclerosis which is derived from the macrophage-induced oxidation of low-density lipoproteins (LDLs), alongside the accumulation of cholesterol. Calcification of the vertebral artery occurs when there is excess calcium and phosphate deposition in the vessel. Dissection of the vertebral artery can lead to the formation of a hematoma causing stenosis of the vertebral artery. Fibromuscular dysplasia can result in stenosis due to the deposition of collagen fibers in the tunica media, intima, or adventitia. Giant cell arteritis, an autoimmune disorder, causes inflammation of the internal elastic membrane resulting in eventual stenosis of the artery. Neurofibromatosis type 1, an autosomal dominant disorder, results in the stenosis of the vertebral artery due to the altered function of neurofibromin. Mechanical compression of the vertebral artery by bone can also cause stenosis of the vertebral artery. Digital subtraction angiography (DSA) is considered the current gold standard in diagnosing vertebral artery stenosis; however, its associated morbidity and mortality have led to increased use of noninvasive techniques such as duplex ultrasonography (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). Currently, asymptomatic and symptomatic vertebral artery stenoses are treated by risk factor modification and medical treatment. However, it is recommended that surgical (endarterectomy, reconstruction, and decompression) and endovascular (balloon coronary, baremetal, and drug-eluting stents) treatments are also used for symptomatic vertebral artery stenosis.

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