Vertebrobasilar insufficiency surgery
| Vertebrobasilar insufficiency
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Differentiating Vertebrobasilar insufficiency from other Diseases |
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Diagnosis |
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Treatment |
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Vertebrobasilar insufficiency surgery On the Web |
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American Roentgen Ray Society Images of Vertebrobasilar insufficiency surgery |
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Directions to Hospitals Treating Vertebrobasilar insufficiency |
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Risk calculators and risk factors for Vertebrobasilar insufficiency surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4]
Overview
The most widely used therapeutic protocol is the inventional therapy.
Surgery
Open operations are rarely performed to treat vertebral artery occlusive disease, and no randomized trials have addressed operative procedures for posterior cerebral circulation disease, but studies of surgical treatment have demonstrated the feasibility of endarterectomy and vessel reconstruction.[1]
Indications for Surgery
There isn't guideline about the indication for surgery accepted by most reseachers. But some researchers suggest that:
- The minimal stenosis extent to meet the reconstruction surgery is
- 1.stenosis 60% diameter in both vertebral arteries if both are patent and complete
- 2.the same degree of stenosis in the dominant vertebral artery if the opposite vertebral artery is hypoplastic,ends in a posteroinferior cerebellar artery, or is occluded[2]
In appropriately selected patients with atherosclerosis:
If the lesion locates at the origin,we can choose:
- 1. trans-subclavian vertebral endarterectomy.
- 2. transposition of the vertebral artery to the ipsilateral common carotid artery
- 3. reimplantation of the vertebral artery with vein graft extension to the subclavian artery
If the lesion invades the distal part,we can choose
- 1. trans-subclavian vertebral endarterectomy
- 2. anastomosis of the principal trunk of the external carotid artery to the vertebral artery
The Interventional Therapy
Some reports suggest that the endovasuclar treatment have a high technical success rate(95%)[3], but meanwhile,it has a high rate of restenosis.The drug elute stent is believed to be the solution for decreasing the in-stent restenosis rate.[4] No matter what kind of stents used to treat the VBI, there isn't enough evidence to support the safety and effectiveness. In recent years,the intravenous thrombolysis(IVT)and intra-arterial thrombolysis(IAT)and mechanical thrombectomy are developed to treat the embolismof vertebrobasilar artery,but still need the ramdom control trials to prove the safety and effectiveness. In patient with acute basilar artery occlusion（BAO），the IVT within 4.5 hours is widely accepted for its safety and efficacy.[5] And mechanical thrombectomy is developed to treat the BAO, like MERCI-retriever device and Solitaire device.[6]
References
- ↑ Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL et al. (2011)2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. J Am Coll Cardiol 57 (8):1002-44. DOI:10.1016/j.jacc.2010.11.005 PMID:[1]
- ↑ Lee CJ, Morasch MD (2011) Treatment of vertebral disease: appropriate use of open and endovascular techniques. Semin Vasc Surg 24 (1):24-30. [2] PMID: 21718929
- ↑ Coward LJ, Featherstone RL, Brown MM (2005)Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis. Cochrane Database Syst Rev (2):CD000516. DOI:10.1002/14651858.CD000516.pub2 PMID: [3]
- ↑ Ogilvy CS, Yang X, Natarajan SK, Hauck EF, Sun L, Lewis-Mason L et al. (2010) Restenosis rates following vertebral artery origin stenting: does stent type make a difference? J Invasive Cardiol 22 (3):119-24. PMID: 20197579
- ↑ van der Hoeven EJ, Schonewille WJ, Vos JA, Algra A, Audebert HJ, Berge E et al. (2013) The Basilar Artery International Cooperation Study (BASICS): study protocol for a randomised controlled trial. Trials 14 ():200. DOI:10.1186/1745-6215-14-200 PMID: 23835026
- ↑ Roth C, Papanagiotou P, Behnke S, Walter S, Haass A, Becker C et al. (2010) Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke 41 (11):2559-67. DOI:10.1161/STROKEAHA.110.592071 PMID: 20947848