eMedicine Specialties > Neurosurgery > Vascular
Vertebral Artery Atherothrombosis: Follow-up
Updated: Feb 20, 2007
Outcome and Prognosis
Results following both proximal and distal vertebral artery reconstructions are generally equal to or better than those reported for other forms of cerebrovascular revascularizations. In experienced hands, the combined stroke and death rates are 4% or less. Long-term patency of the reconstructions is excellent. More than 80% of patients experience symptom relief following surgical reconstruction.
Future and Controversies
Modern surgical advances have resulted in a safe and durable mode of therapy for patients with documented symptomatic vertebrobasilar ischemia. On the horizon is the application of minimally invasive endovascular interventions, which have spread throughout the field of vascular and cardiovascular surgery. Balloon angioplasty, along with endoluminal stent placement, has already been tried in proximal vertebral disease with some reported early technical success. The complication rate and long-term success of endoluminal procedures are still unknown; therefore, this form of therapy is currently considered investigational.
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Follow-up: Vertebral Artery Atherothrombosis |
| Multimedia: Vertebral Artery Atherothrombosis |
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References
Berguer R, Kieffer E. Surgery of the Arteries of the Head. New York: Springer-Verlag. 1992.
Berguer R, Morasch MD, Kline RA. A review of 100 consecutive reconstructions of the distal vertebral artery for embolic and hemodynamic disease. J Vasc Surg. May 1998;27(5):852-9. [Medline].
Berguer R, Flynn LM, Kline RA, Caplan L. Surgical reconstruction of the extracranial vertebral artery: management and outcome. J Vasc Surg. Jan 2000;31(1 Pt 1):9-18. [Medline].
Caplan L. Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. Stroke. Aug 2000;31(8):2011-23. [Medline].
Chastain HD, Campbell MS, Iyer S, et al. Extracranial vertebral artery stent placement: in-hospital and follow-up results. J Neurosurg. Oct 1999;91(4):547-52. [Medline].
Cloud GC, Markus HS. Vertebral Artery Stenosis. Curr Treat Options Cardiovasc Med. Apr 2004;6(2):121-127. [Medline].
Hauth EA, Gissler HM, Drescher R, et al. Angioplasty or stenting of extra- and intracranial vertebral artery stenoses. Cardiovasc Intervent Radiol. Jan-Feb 2004;27(1):51-7. [Medline].
Kieffer E, Praquin B, Chiche L, et al. Distal vertebral artery reconstruction: long-term outcome. J Vasc Surg. Sep 2002;36(3):549-54. [Medline].
Lin YH, Juang JM, Jeng JS, et al. Symptomatic ostial vertebral artery stenosis treated with tubular coronary stents: clinical results and restenosis analysis. J Endovasc Ther. Dec 2004;11(6):719-26. [Medline].
Malek AM, Higashida RT, Phatouros CC, et al. Treatment of posterior circulation ischemia with extracranial percutaneous balloon angioplasty and stent placement. Stroke. Oct 1999;30(10):2073-85. [Medline].
Rancurel G, Kieffer E, Arzimanglou A. Hemodynamic vertebrobasilar ischemia: Differentiation of hemodynamic and thromboembolic mechanisms. In: erguer R, Caplan LR, eds, Vertebrobasilar Arterial Disease. St. Louis: Quality Medical Publishing, Inc;1992:40-51.
Yates PO. Atheromatous lesions of the vertebral arteries and brain infarction. In: Vertebrobasilar Arterial Disease. St. Louis: Quality Medical Publishing, Inc;1992:3-10.
Further Reading
Keywords
vertebral artery atherothrombosis, atherosclerosis, atherosclerotic lesions, atherosclerotic plaque, vertebral artery stenosis, hemodynamic symptoms, vertebrobasilar ischemia, fibromuscular dysplasia, FMD, carotid artery disease, vasculopathy, Takayasu disease, osteophyte compression, aneurysms, arteritides, anticoagulation, vertebral artery reconstruction, subclavian-vertebral artery endarterectomy, saphenous vein bypass
Follow-up: Vertebral Artery Atherothrombosis