Vertebral artery stenosis

被引：15

作者：

Cloud G.C. ^{[1
]}

Markus H.S. ^{[1
]}

机构：

[1] Clinical Neuroscience, St. George's Hospital Medical School, London SW17 0RE, Cranmer Terrace

来源：

Current Treatment Options in Cardiovascular Medicine | 2004年 / 6卷 / 2期

关键词：

Clopidogrel; Vertebral Artery; Dipyridamole; Subclavian Artery; Main Drug Interaction;

D O I：

10.1007/s11936-004-0040-5

中图分类号：

学科分类号：

摘要：

Stenosis of the vertebral artery (VA) in either its extra- or intracranial portions is an important cause of posterior circulation stroke. Diagnosis of VA stenosis by noninvasive imaging techniques is improving and new endovascular and medical treatments are now available. However, the natural history of VA stenotic lesions is not known and its optimum management is unclear. Symptomatic VA stenosis should be initially heated with established antiplatelet agents. There is no proven indication for anticoagulation in cases of VA stenosis. Case series have shown that angioplasty and stenting for proximal extracranial VA stenosis have a low perioperative complication rate and are effective in restoring luminal diameter. Evidence from randomized trials on its long-term efficacy versus medical therapy is not available. Regarding current evidence where symptoms are refractory to antiplatelet treatment, or where recurrent stroke risk is considered increased due to either an incomplete circle of Willis or an anomalous VA circulation, it can be considered in centers with experience of the procedure. Randomized trials comparing stenting with medical therapy are required. Surgery may be a viable alternative to angioplasty and stenting, but only in a few specialist centers. Evidence from randomized controlled trials of medical and other interventions for VA stenosis are required. Copyright © 2004 by Current Science Inc.

引用

页码：121 / 127

页数：6

共 37 条

[1]

Bamford J., Sandercock P., Dennis M., Et al., Classification and natural history of clinically identifiable subtypes of cerebral infarction, Lancet, 337, pp. 1521-1526, (1991)

[2]

Bogousslavsky J., Van Melle G., Regli F., The Lausanne Stroke Registry: Analysis of 1,000 consecutive patients with first stroke, Stroke, 19, pp. 1083-1092, (1988)

[3]

Caplan L.R., Amarenco P., Rosengart A., Et al., Embolism from vertebral artery origin occlusive disease, Neurology, 42, pp. 1505-1512, (1992)

[4]

Cloud G.C., Markus H.S., Diagnosis and management of vertebral artery stenosis, QJM, 96, pp. 27-54, (2003)

[5]

Qureshi A.I., Ziai W.C., Yahia A.M., Et al., Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: A multicenter study, Neurosurgery, 52, pp. 1033-1039, (2003)

[6]

Wityk R.J., Chang H.M., Rosengart A., Et al., Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry, Arch. Neurol., 55, pp. 470-478, (1998)

[7]

Moufarrij N.A., Little J.R., Furlan A.J., Et al., Basilar and distal vertebral artery stenosis: Long-term follow-up, Stroke, 17, pp. 938-942, (1986)

[8]

Akins P.T., Pilgram T.K., Cross III D.T., Moran C.J., Natural history of stenosis from intracranial atherosclerosis by serial angiography, Stroke, 29, pp. 433-438, (1998)

[9]

Benesch C.G., Chimowitz M.I., Best treatment for intracranial arterial stenosis? 50 years of uncertainty, Neurology, 55, pp. 465-466, (2000)

[10]

Mohr J.P., Thompson J.L., Lazar R.M., Et al., A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke, N. Engl. J. Med., 345, pp. 1444-1451, (2001)

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