Abstract
Introduction: While vertebral artery stenting (VAS) in acute ischemic stroke (AIS) has been previously studied, the safety and efficacy of VAS for resolution of chronic vertebrobasilar insufficiency (VBI) symptoms outside of the AIS setting has not been extensively evaluated. Symptoms associated with chronic VBI include dizziness, vertigo, diplopia, blurred vision, ataxia and syncope. Hypothesis: VAS for patients with chronic VBI symptoms is safe, will have few peri-procedural complications and improve clinical symptoms. Methods: Between January 2005 and June 2015, our group performed VAS on 94 patients after careful evaluation of the contribution of contralateral vertebral artery and posterior communicating artery flow into the basilar artery. Of the 94, 38.2% (n=36) had a clinical history of chronic VBI symptoms; AIS was excluded by imaging and consultation with a stroke neurologist. A detailed retrospective chart review was completed for these patients. Multiple variables including age, sex and cardiovascular co-morbidities were studied. Improvement of clinical symptoms was evaluated by chart review of follow-up visits. Results: There were no major complications including strokes or deaths from VAS in 36 patients (25 Males, 11 Females; Age 71.1, SD 9.6). Two patients had minor complications: an allergic reaction to contrast and GI bleed that were effectively medically managed. Prior to VAS stenting, 31 of 36 patients reported dizziness, vertigo, syncope or falls, 1 reported diplopia or blurry vision, and 4 reported multiple VBI symptoms. Overall, 77.8% reported clinical improvement on follow-up (3 patients were lost to follow-up). Conclusions: Given a zero percent stroke and death rate at 30 days and a 78% overall improvement of clinical symptoms, we conclude that VAS is a safe and efficacious procedure for chronic VBI when performed by experienced neuro-interventional radiologists in carefully selected patients.
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