Vertebral Artery Stenting
Vertebral Artery Stenting (VAS)
Vertebral Artery Stenting (VAS) is a minimally invasive procedure used to open a narrowed vertebral artery—one of the two major blood vessels in the back of the neck that supply the brainstem and cerebellum (the "posterior circulation"). By placing a metal mesh stent to widen the artery, this procedure restores critical blood flow and is primarily used to prevent a posterior stroke and resolve symptoms like chronic vertigo or "drop attacks."
When You Should Consider Vertebral Artery Stenting
Vertebral Artery Stenosis: Blockage of more than 50% in patients who continue to experience symptoms despite taking maximum medical therapy.
Posterior Circulation Symptoms: Recurrent spells of dizziness (vertigo), double vision (diplopia), loss of balance, or sudden "drop attacks" where the legs give way.
Failed Medical Management: Patients who have suffered a mini-stroke (TIA) or minor stroke while already taking blood thinners and statins.
High-Risk Anatomy: When the narrowing is located at the "origin" (where the vertebral artery branches off the subclavian artery in the chest), making open surgery difficult.
Inadequate Collateral Flow: When the other vertebral artery is also narrow or missing, making the blocked artery the sole supply of blood to the brainstem.
Methods of Vertebral Artery Stenting
Balloon-Expandable Stenting: The stent is mounted on a balloon and expanded directly into the blockage, often used for narrowing at the artery's origin.
Drug-Eluting Stents (DES): The same type used in heart surgeries; these are coated with medication to prevent the growth of scar tissue (restenosis) inside the vessel.
Self-Expanding Stenting: A flexible stent released from a catheter that automatically expands to fit the artery, often used for narrowing higher up in the neck.
Pre-Dilation Angioplasty: Gently widening the blockage with a small balloon before the stent is placed to ensure a smooth fit.
Embolic Protection: In some cases, a tiny filter is used to catch any loose plaque fragments during the procedure to prevent them from reaching the brainstem.
How Vertebral Artery Stenting Is Performed
Vascular Access: A small puncture is made in the femoral artery (groin) or radial artery (wrist) to serve as the entry point for the surgical catheters.
Navigation: Using real-time X-ray (fluoroscopy), the surgeon guides a catheter through the aorta and into the origin of the vertebral artery in the chest or neck.
Angioplasty: A tiny, high-pressure balloon is guided to the site of the narrowing and inflated to "pre-dilate" the segment and prepare it for the stent.
Stent Deployment: The metal mesh stent is deployed across the blockage. It acts as a permanent internal scaffold, pressing the plaque against the artery walls to keep the vessel open.
Flow Verification: Contrast dye is injected to confirm that blood is flowing freely through the stent and reaching the brainstem and cerebellum.
Final Removal: Once the stent is secure and properly "apposed" (snug) against the wall, the balloon and delivery catheters are removed.
Pre-Procedure Preparation
Diagnostic Imaging: Confirmation of the degree of narrowing via CT Angiography (CTA), MR Angiography (MRA), or Digital Subtraction Angiography (DSA).
Dual Antiplatelet Therapy (DAPT): Taking Aspirin and Clopidogrel (Plavix) for 5–7 days prior is mandatory to prevent blood clots from forming on the new metal stent.
Fasting (NPO): No food or drink for 8–12 hours before the procedure, which is usually performed under local anesthesia with sedation.
Neurological Baseline: A thorough exam of speech, vision, and motor skills is performed so the surgical team can monitor for any changes in real-time.
Tests Before Vertebral Artery Stenting
CT Angiography (CTA): Provides a high-resolution 3D view of the calcium and plaque buildup to help the surgeon select the correct stent diameter.
Digital Subtraction Angiography (DSA): The gold standard for measuring the exact length of the blockage and the health of the surrounding vessels.
Doppler Ultrasound: A non-invasive test used to measure the speed of blood flow through the vertebral arteries in the neck.
Blood Panels: Routine screens to check kidney function (for processing the contrast dye) and ensure blood clotting levels are safe for surgery.
Life After Vertebral Artery Stenting
Hospital Stay: Typically 24 hours in a specialized unit for close monitoring of blood pressure and neurological status.
Immediate Recovery: Patients must remain on bed rest for about 6 hours post-op to ensure the access site in the groin or wrist heals properly.
Strict Medication Adherence: This is mandatory; missing a single dose of blood thinners in the first 6–12 months can cause the stent to clog (stent thrombosis).
Activity: Strenuous activity and heavy lifting are restricted for 1 week, though most patients experience immediate relief from dizzy spells.
Follow-up Schedule: Mandatory Doppler Ultrasound or CTA scans are performed at 1 month, 6 months, and then annually to monitor for re-narrowing (restenosis).
Benefits of Vertebral Artery Stenting
Immediate Symptom Relief: Most patients report a near-instant cessation of vertigo, "drop attacks," and double vision as blood flow is restored.
Minimally Invasive: Avoids a complex surgery in the deep neck or chest, significantly reducing recovery time and local trauma.
Real-time Monitoring: Since it is usually performed under sedation, the surgeon can talk to the patient throughout the procedure to ensure brainstem function is perfect.
Effective Stroke Prevention: Long-term results show that VAS is highly effective at keeping the vertebral artery open and preventing strokes in the posterior circulation of the brain.