Endovascular management of extracranial vertebral artery stenosis

Approximately 20% of ischemic strokes involve the posterior circulation, primarily supplied by the vertebrobasilar system. While much is known about the stroke risk of vertebrobasilar stenotic disease in general, particularly those involving intracranial pathology, extracranial vertebral artery stenosis remains an underinvestigated pathology. In this narrative review, we highlight retrospective, prospective, and randomized trial data on extracranial vertebral artery diseases with a particular focus on the role of endovascular stenting in its management. We also discuss the role of advanced imaging modalities such as quantitative magnetic resonance angiography for stroke risk stratification and patient selection for stenting.