[Preocclusive stenosis of the extracranial vertebral artery. Treatment by percutaneous transluminal angioplasty and insertion of endoprosthesis]. / Estenosis preoclusiva de la arteria vertebral extracraneal. Tratamiento mediante angioplastia transluminal percutánea y colocación de endoprótesis.

ABSTRACT

INTRODUCTION: Atherosclerotic occlusive disease of the extracranial portion of the vertebral artery is relatively frequent and is usually related to vertebrobasilar ischemia. Due to the lack of a noninvasive diagnostic technique, at present it is often not diagnosed. Surgical treatment is difficult and risky. Percutaneous transluminal angioplasty (PTA) is only partly useful due to a high rate of restenosis. The recent development of stenting has led to an evident improvement of PTA results, reducing restenosis and offering an effective treatment with low morbidity and mortality. CLINICAL CASE Sixty year old male patient, smoker and moderate drinker, who is hospitalized due to repeated ischemic strokes (cerebellar stroke in the left posterior and interior inferior cerebellar arteries, and cerebral stroke at occipito-parietal and ipsilateral capsulo-thalamic levels) in spite of antithrombotic treatment. Angiography showed a) occlusion of the left vertebral artery; b) preocclusive stenosis of the right vertebral artery in the ostium; c) fetal origin of the right posterior cerebral artery, and d) left hypoplasic posterior communicating artery. PTA and stent placement at the right vertebral artery is performed with an excellent angiographic result, a partial recovery of neurological symptomatology and absence of new episodes of cerebral ischemia during a three-month follow-up. CONCLUSION: Percutaneous transluminal angioplasty and stent placement is an effective low morbidity-mortality treatment in occlusive atherosclerosis of the vertebral artery, although further randomized multicenter studies are required in order to validate this conclusion.