Vertebral artery stenosis - surgical, endovascular or hybrid treatment strategy?

Abstract

The main idea of this literature review is based on the uncertainty in the current recommendations regarding the treatment of patients with vertebrobasilar insufficiency (VBI) caused by the presence of hemodynamically significant stenosis of the vertebral artery (VA). The authors present comparative results of medical, endovascular, open surgical methods of treatment, demonstrating the advantages and disadvantages of each of them, describe new hybrid correction options with substantiation of their effectiveness and safety. The results of treatment of patients with VBI without VA stenosis, with atherosclerotic lesions of the internal carotid arteries are presented. The role of carotid endarterectomy in these conditions has been substantiated. Rare cases of VBI caused by abnormal origin of VA from atherosclerotically changed common carotid artery are demonstrated. The treatment options for patients with combined hemodynamically significant stenosis of the VA and carotid arteries are described. The emphasis is made on the need to stratify the risk of complications in this cohort of patients using modern programs to implement a personalized approach to treatment.