Vertebral artery intervention: What you need to know
The article was consulted with Dr. Nguyen Luong Tan - Head of Cardiology Department - Cardiovascular Center - Vinmec Central Park International General Hospital.
The vertebral artery is a large artery in the neck that usually originates from the subclavian artery and functions as a blood supply to the upper spinal cord, brainstem, cerebellum, and posterior brainstem. In some cases of patients with cerebral circulatory insufficiency due to stenosis of the vertebral arteries, doctors need to consider and prescribe stent intervention to achieve effective treatment.
1. What is cerebral circulatory insufficiency?
Insufficiency of cerebral circulation is a common disease in people over the age of 50 with manifestations such as headache, neck pain, dizziness with the main cause of this condition being atherosclerosis. This is a very dangerous disease because if prolonged, it can lead to stroke, ischemic stroke of the vertebral column, when blood clots completely block and the patient dies due to respiratory failure, circulatory failure, cerebral edema.
In fact, the brain is nourished by two systems: the carotid artery system in the front, which governs most of the cerebral hemispheres, and the basal vertebrae system behind. While the carotid system has an abundant collateral circulation, its compensatory capacity is relatively good, making the manifestations of carotid circulatory insufficiency rare, the symptoms of cerebral circulatory insufficiency of the vertebral artery system The vertebral column is more common because the output to the vertebral artery is only 10% of the output to the carotid artery.
Insufficiency of cerebral circulation in the basilar vertebral artery system is very common with the main cause being atherosclerosis, localized at the origin of the cerebral artery. When other combined factors such as low arterial blood pressure are present, there are symptoms of cerebral circulatory insufficiency. Cervical spondylosis is also a possible cause of the disease, depending on the degree of joint degeneration, the spine on the side of the spine causes compression of the vertebral artery.
2. Intervention of vertebral artery with stent like?
Stenting of the vertebral artery is performed as follows:
Treatment of ASA, Clopidogrel for more than 3 days The inlet can be femoral artery or radial artery, brachial artery JR4, IMA, MP, usually Neuron Max longsheat Heparin 50-70 units/kg: ACT 240-300 seconds Usually use 0.035'' wire in subclavian artery Roadmap guidance, 0.014'' wire with/without distal protector Anterior balloon angioplasty in the case of tight stenosis, the vessel diameter is usually 2.75-5.5 mm, the average 4.5 mm, the average length 5-10 mm. Use of coronary, renal, or carotid stents For inlet damage, use balloon expansion stents rather than carotid stents. Usually placed in the subclavian artery about 2mm High rates of restenosis up to 43% are often related to incomplete coverage of the lesion, stent resistance Consider drug-eluting stents (DES), preferred stent expansion balloon because of its good support Determine the exact position, slowly inject pressure about 8 atm Pull the balloon into the stent to 12-14 atm to limit the risk of dissection of the distal segment, flare the tip of the stent Possible Use nitroglycerin vasodilator to accurately assess vessel size Always do clinical assessment, re-evaluate vascular status after intervention, assess for complications When removing the distal protective parachute, usually guide guiding to the stent before withdrawing. umbrella
The success rate of the procedure is about 94-100%, but there are still some rare complications such as dissection, vasospasm, thrombosis, bleeding, transient cerebrovascular accident and true stroke. .
Vertebral artery stenosis can cause infarction and the risk of falling, so patients need to be diagnosed early for early treatment. Vinmec Hospital has a full range of lighting machines and equipment for vertebral artery intervention to achieve the most effective treatment results possible.