Wewnątrznaczyniowe leczenie objawowych zwężeń proksymalnych odcinków tętnic kręgowych

Two vertebral arteries, basilar artery and their branches create posterior circulation system. This system provides blood supply to the brainstem, thalamus, cerebellum and parts of the temporal and occipital lobes. Ischemic strokes account for about 70–80% of all strokes and posterior circulation strokes accounts for about 20–30% of them. Symptomatic vertebral artery stenosis is a well-known risk factor for vertebrobasilar (VB) stroke. Clinical symptoms of VB ischaemia are very heterogenous due to wide area of vascular supply. Among patients after posterior circulation stroke, vertebral artery stenosis > 50% occurs in 20% of the patients and in 9% is the main cause of stroke. First line treatment consists of risk factors modification and pharmacotherapy. Patients who fail medical management are considered for interventional therapy — either surgical or endovascular. First case of vertebral artery balloon angioplasty was reported in 1981, nowadays vertebral artery stenting is the routine treatment option, described in ESC guidelines in 2011. Vertebral artery stenting is safe and is associated with low percentage of complications. Drug-eluting stents at the ostial vertebral location may reduce in-stent restenosis rate comparing to bare-metal stents, but the results from literature are not conclusive. High restenosis rate after vertebral artery stenting remains a concern, however it could be succesfully treated with reangioplasty in vast majority of cases.