Transcatheter Placement of Extracranial Vertebral Artery Stent(s)

Name of the Procedure:

Common Name(s): Vertebral artery stenting
Medical Term: Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel

Summary

Vertebral artery stenting is a minimally invasive procedure to open up narrowed or blocked vertebral arteries, which supply blood to the brain. This is achieved by inserting a stent – a small metal mesh tube – via a catheter to hold the artery open and restore blood flow.

Purpose

Medical Condition: Atherosclerosis or stenosis of the vertebral arteries
Goals: To improve blood flow to the brain, prevent stroke, and alleviate symptoms such as dizziness, vertigo, or blurred vision.

Indications

• Symptoms of vertebrobasilar insufficiency: dizziness, vertigo, visual disturbances, or even transient ischemic attacks (TIAs).
• Significant stenosis (narrowing) of the vertebral artery confirmed by imaging studies.
• Failure of medical management (e.g., medications and lifestyle changes).

Preparation

• Pre-Procedure Instructions: Patients may need to fast for 6-8 hours before the procedure. Specific instructions about medications, especially blood thinners, will be provided.
• Diagnostic Tests: Pre-procedure assessments may include blood tests, echocardiogram, CT angiography, or MRI to assess the extent of the narrowing.

Procedure Description

1. The patient is given a local anesthetic and may also receive sedation.
2. A small incision is made, usually in the groin, and a catheter is threaded through the blood vessels to the affected vertebral artery under X-ray guidance.
3. A stent is then positioned at the site of the narrowing and expanded to open the artery.
4. Radiologic imaging is used throughout the procedure to ensure proper placement of the stent.
5. The catheter is removed, and the incision site is closed.

Tools Used: Catheter, stent, imaging equipment for X-ray guidance (fluoroscopy)

Duration

The procedure typically takes 1-2 hours depending on the complexity.

Setting

Performed in a hospital, often in a specialized area such as an interventional radiology suite or catheterization lab.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Nurses
• Anesthesiologist (if general anesthesia is used)
• Radiology Technologist

Risks and Complications

• Common Risks: Bleeding, infection at the catheter site, and allergic reactions to contrast dye.
• Rare Risks: Blood vessel damage, arterial dissection, stroke, or adverse reaction to anesthesia.

Benefits

The procedure aims to significantly improve blood flow to the brain, reducing the risk of stroke and alleviating symptoms like dizziness and visual disturbances. Benefits are often noticed shortly after the procedure.

Recovery

• Post-Procedure Care: Patients may need to lie flat for a few hours to prevent bleeding from the catheter site.
• Expected Recovery Time: Most patients can return to normal activities within a few days. Follow-up appointments are essential to monitor the stent and overall vascular health.

Alternatives

• Lifestyle Changes and Medication: Control risk factors like hypertension, hyperlipidemia, and smoking.
• Surgical Options: Open surgical revascularization, though it’s more invasive than stenting.
• Pros and Cons: Alternatives may carry different risk profiles and effectiveness; stenting is less invasive with a quicker recovery time compared to open surgery.

Patient Experience

During the procedure, the patient might feel pressure at the incision site or a brief, mild discomfort as the catheter is inserted. Post-procedure, patients are monitored for any immediate complications. Pain at the catheter site can be managed with medication, and most patients feel back to normal within a few days.

Comfort measures include sedatives to ease anxiety and local anesthetics to minimize discomfort at the incision site.