Vertebral Artery Interventions: A Comprehensive Updated Review.

IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Current Cardiology Reviews Pub Date : 2023-01-01 DOI:10.2174/1573403X18666220317093131
Oscar Maitas, Tamunoinemi Bob-Manuel, Justin Price, Abdullah Noor, Koyenum Obi, Nelson Okoh, Kiran Garikapati, Jeong Kim, Sanjida Jahan, James S Jenkins
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Abstract

Patients with posterior circulation ischemia due to vertebral artery stenosis account for 20 to 25% of ischemic strokes and have an increased risk of recurrent stroke. In patients treated with medical therapy alone, the risk of recurrence is particularly increased in the first few weeks after symptoms occur, with an annual stroke rate of 10 to 15%. Additionally, obstructive disease of the vertebrobasilar system carries a worse prognosis, with a 30% mortality at 2-years if managed medically without additional surgical or endovascular intervention. Percutaneous transluminal angioplasty and stenting of symptomatic vertebral artery stenosis are promising options widely used in clinical practice with good technical results; however, the improved clinical outcome has been examined in various clinical trials without a sufficient sample size to conclusively determine whether stenting is better than medical therapy. Surgical revascularization is an alternative approach for the treatment of symptomatic vertebral artery stenosis that carries a 10-20% mortality rate. Despite the advances in medical therapy and endovascular and surgical options, symptomatic vertebral artery stenosis continues to impose a high risk of stroke recurrence with associated high morbidity and mortality. This review aims to provide a focused update on the percutaneous treatment of vertebral artery stenosis, its appropriate diagnostic approach, and advances in medical therapies.

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椎动脉介入治疗:一篇全面更新的综述。
由于椎动脉狭窄导致后循环缺血的患者占缺血性中风的20%至25%,并且复发性中风的风险增加。在单独接受药物治疗的患者中,在症状出现后的最初几周,复发的风险尤其增加,每年的中风率为10%至15%。此外,椎基底动脉系统阻塞性疾病的预后更差,如果在没有额外手术或血管内干预的情况下进行医学治疗,2年时死亡率为30%。症状性椎动脉狭窄的经皮腔内血管成形术和支架置入术是临床上广泛应用的有前景的选择,具有良好的技术效果;然而,在没有足够的样本量来最终确定支架置入术是否优于药物治疗的情况下,各种临床试验都对改善的临床结果进行了检查。手术血运重建是治疗症状性椎动脉狭窄的一种替代方法,死亡率为10-20%。尽管在药物治疗、血管内和手术选择方面取得了进展,但有症状的椎动脉狭窄仍然会带来中风复发的高风险,并伴有高发病率和高死亡率。这篇综述旨在对经皮治疗椎动脉狭窄、其适当的诊断方法和医学治疗进展进行重点更新。
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来源期刊
Current Cardiology Reviews
Current Cardiology Reviews CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
10.50%
发文量
117
期刊介绍: Current Cardiology Reviews publishes frontier reviews of high quality on all the latest advances on the practical and clinical approach to the diagnosis and treatment of cardiovascular disease. All relevant areas are covered by the journal including arrhythmia, congestive heart failure, cardiomyopathy, congenital heart disease, drugs, methodology, pacing, and preventive cardiology. The journal is essential reading for all researchers and clinicians in cardiology.
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