Vertebral Artery Stenting

Vertebral Artery Stenting

Vertebral artery stenting is a minimally invasive endovascular procedure used to open narrowed vertebral arteries, which provide critical blood supply to the brainstem and the back of the brain. It is primarily performed to reduce the risk of a vertebrobasilar stroke in patients who have already experienced symptoms like vertigo or minor strokes despite medical treatment. By placing a small mesh tube within the vessel, the procedure restores healthy blood flow to the brain.

When You Should Consider Vertebral Artery Stenting

• Symptomatic Narrowing: If you have 50% or greater narrowing of the vertebral artery and continue to experience TIAs (mini-strokes) or minor strokes.

• Persistent Vertigo: Recurrent dizziness or balance issues caused by "vertebrobasilar insufficiency" that does not improve with medication.

• Failed Medical Therapy: For patients who have recurrent neurological symptoms despite taking blood thinners and high-dose cholesterol medications.

• High-Risk Surgical Anatomy: Because traditional open surgery on these deep arteries is highly complex, stenting is the preferred surgical alternative for most patients.

• Posterior Circulation Stroke: If a previous stroke has been traced back to a blockage in the vertebral artery system.

How Is Performed

• Anaesthesia: The procedure is performed under local anaesthesia with conscious sedation or general anaesthesia, taking about 1 to 2 hours.

• Access: A small incision is made in the groin (femoral artery) or the wrist (radial artery) to insert a thin, flexible catheter.

• Guidance: Using real-time X-ray (fluoroscopy), the specialist guides a wire and catheter through the vascular system to the narrowed section of the vertebral artery.

• Stent Placement: A small, specialized mesh tube (stent) is guided through the catheter and positioned exactly at the site of the blockage.

• Expansion: The stent is expanded, pushing against the artery walls to flatten the plaque and keeping the vessel held open to restore full blood flow.

• Completion: The catheter is removed, and the small access site in the groin or wrist is closed with a pressure device or a small stitch.

[Image showing a catheter-guided stent placement in the neck]

Pre-Procedure Preparation

• Diagnostic Angiography: A detailed mapping of your arteries to determine the exact location and degree of the narrowing.

• Blood Thinning Protocol: You will likely be started on aspirin and clopidogrel (Plavix) several days before the procedure to prevent clots.

• Kidney Function Tests: To ensure your kidneys can safely process the contrast dye used during the X-ray guidance.

• Fasting: Following "nothing by mouth" instructions for 6–8 hours prior to your scheduled procedure.

• Medication Audit: Reviewing all current supplements and medications, especially any that affect blood clotting.

Tests Before Vertebral Artery Stenting

• CT Angiogram (CTA) or MRA: High-resolution 3D imaging used to visualize the blood vessels in the neck and brain.

• Doppler Ultrasound: A non-invasive test to measure the speed and direction of blood flow through the vertebral arteries.

• Neurological Exam: A baseline assessment of your strength, balance, and coordination.

• ECG: A routine heart check to confirm cardiovascular stability for the duration of the procedure.

Life After Vertebral Artery Stenting

• Hospital Stay: Most patients stay in the hospital overnight for close neurological observation and are discharged the following day.

• Antiplatelet Therapy: This is the most critical part of aftercare; you must take Dual Antiplatelet Therapy (DAPT), typically aspirin and clopidogrel, for 1 to 6 months to prevent clots.

• Activity Restrictions: Avoid heavy lifting and strenuous exercise for about 5 to 7 days to allow the artery access site (groin or wrist) to heal.

• Long-term Monitoring: Regular Doppler ultrasound or CT scans are performed at 3, 6, and 12 months to ensure the stent remains open and free of new plaque.

• Lifestyle Management: Continued management of blood pressure and cholesterol is essential to prevent "restenosis" (narrowing again).

Why Specialized Treatment Is Highly Effective

• Minimally Invasive: Avoids the need for large neck incisions, leading to less pain and a significantly faster recovery than open surgery.

• Stroke Prevention: Successfully opening the artery provides a durable defense against life-threatening strokes in the back of the brain.

• Immediate Flow Restoration: Patients often experience an immediate improvement in blood supply to the brainstem and cerebellum.

• High Success in the Neck: Stenting the portion of the artery in the neck (extracranial) is considered very safe with low complication rates.

• Advanced Imaging Guidance: The use of high-tech fluoroscopy allows for sub-millimeter precision when placing the stent within the vessel.