Endovascular treatment of noncarotid extracranial cerebrovascular disease.

The last two decades have witnessed a growing application of endovascular techniques for the treatment of atherosclerotic disease of the extracranial vertebral arteries, subclavian arteries, and brachiocephalic artery. Beginning with simple balloon angioplasty, these minimally invasive techniques have now progressed to the use of stent-supported angioplasty. Stent-supported angioplasty is currently providing a therapeutic alternative to traditional methods of open surgery for revascularization of these vessels and increasing the therapeutic options available for patients who have failed maximal medical therapy. Additionally, endovascular techniques are also being used successfully to treat a variety of nonatherosclerotic diseases affecting the noncarotid extacranial arteries, such as inflammatory, radiation, and anastomotic-graft strictures; acute intimal dissection; traumatic and spontaneous arteriovenous fistulas; and aneurysms or pseudoaneurysms. Continued innovation and refinement of endovascular devices and techniques will inevitably improve technical success rates, reduce procedure-related complications, and broaden the endovascular therapeutic spectrum for extracranial cerebrovascular disease.