Is there utility for endovascular stenting of severe symptomatic vertebral artery stenosis?

This is a great question and one I remember asking during fellowship. There have been several randomized trials that touched on vertebral stenting (CAVATAS, SAMMPRIS, VISSIT, VAST), but VIST is the only one I recall that focused specifically on vertebral artery stenosis. The earlier trials had mixed results with relatively few vertebral patients, and most of the higher complication rates were seen with intracranial rather than extracranial interventions.

VIST itself showed a signal favoring stenting in carefully selected symptomatic patients, though it didn’t reach statistical significance. Across these studies, the safer and more durable outcomes consistently come from treating extracranial lesions at the vertebral origin (V1 segment).

In pr...