As the main intracranial artery, the vertebral artery plays an important role in blood supply to the brain, mostly originating from bilateral subclavian arteries, and some variations originate from the aortic arch and internal carotid artery.
Vertebral artery stenosis is a common cerebrovascular disease, and atherosclerosis, dissection, aneurysm, thrombosis, and vertebral artery hypoplasia are the main causes of vertebral artery stenosis. Common clinical symptoms include: dizziness, nausea, vomiting, visual rotation, limb weakness, dysphagia, ataxia and diplopia.
Vertebral artery stenosis can be anatomically divided into extracranial vertebral artery stenosis and intracranial vertebral artery stenosis. Stenosis is more common in the V1 and V4 segments of the vertebral artery. The intracranial and extracranial segments of the vertebral artery have different vascular compositions, the intracranial segment does not have an external elastic membrane, and the intima is thinner, and the medial and adventitia have fewer elastic fibers and more branches, and the surgical risk is high.
Vertebral artery stenosis is classified as mild (stenosis less than 50%), moderate (stenosis 50-70%), and severe (stenosis greater than 70%).
Symptomatic vertebral artery stenosis is associated with a high rate of stroke. Symptomatic vertebral artery stenosis can be treated with lifestyle interventions, medications, and surgery.
Life interventions: healthy eating, quitting smoking and drinking.
Medications**: Oral aspirin or clopidogrel and statins may be used. Stent surgery** has been widely promoted in clinical practice because of its small trauma and fast recovery.
The purpose of the stent is to improve blood supply to the vertebral artery and basilar artery supply areas.
Current vertebral artery stents** recommended.
1) Patients with symptomatic vertebral artery extracranial artery stenosis 50 may consider endovascular if the drug is ineffective**.
2) Symptomatic extracranial stenosis of the vertebral artery 70 patients may consider endovascular intervention if the stenosis progressively worsens**.
3) Endovascular intervention may be considered in patients with asymptomatic extracranial stenosis of the extracranial artery 70 if they are accompanied by congenital dysplasia or absence of the contralateral vertebral artery**.
Poststent restenosis is prone due to the proliferation of the stent intima and the organization of stent thrombosis, the acute and chronic inflammation of the blood vessel wall, and the secretion of growth factors leading to vascular intimal hyperplasia, and drug stents can reduce the risk of restenosis to a certain extent.
In addition, it is also necessary to standardize the control of risk factors for cerebrovascular disease and standardize the use of drugs after surgery: antiplatelet, plaque stabilization, quitting smoking and alcohol, and regular reexamination. Autumn and Winter Check-in Challenge