INTRODUCTION: The optimal management of patients with symptomatic severe ostial vertebral artery stenosis (OVAS) is currently unclear. We analyzed the long-term outcome of consecutive patients with OVAS who received either medical treatment (MT) or vertebral artery stenting (VAS). METHODS: Thirty-nine (>70%) patients with severe OVAS were followed for a mean period of 2.8 years. The decision for VAS (n = 10) or MT (n = 29) was left to the clinician. The Kaplan-Meier method was used to assess the risk of recurrent stroke, transient ischemic attack (TIA), or death over the study period. RESULTS: Patients in the VAS group were significantly younger and more likely to have bilateral VA disease (P = 0.04 and P = 0.02). VAS was successfully performed in all ten patients. The periprocedural risk within 30 days was 10% (one TIA). The overall restenosis rate was 10%. One restenosis occurred after 9 months in a patient treated with bare-metal stent. At 4 years of follow-up, VAS showed a nonsignificant trend toward a lower risk for the combined endpoint of TIA and stroke in posterior circulation compared to medical treatment (10% vs. 45%, P = 0.095; relative risk (RR) = 0.24, 95% confidence interval (CI) 0.031-1.85). Patients with bilateral VA disease had a significantly lower recurrence risk after VAS compared with medical treatment (0% vs. 91% at 4 years, P = 0.004; RR 0.10, 95% CI 0.022-0.49) CONCLUSION: VAS was performed without permanent complications in this small series of patients with symptomatic severe OVAS. The long-term benefit seems to be confined to patients with bilateral but not to those with unilateral VA disease.
INTRODUCTION: The optimal management of patients with symptomatic severe ostial vertebral artery stenosis (OVAS) is currently unclear. We analyzed the long-term outcome of consecutive patients with OVAS who received either medical treatment (MT) or vertebral artery stenting (VAS). METHODS: Thirty-nine (>70%) patients with severe OVAS were followed for a mean period of 2.8 years. The decision for VAS (n = 10) or MT (n = 29) was left to the clinician. The Kaplan-Meier method was used to assess the risk of recurrent stroke, transient ischemic attack (TIA), or death over the study period. RESULTS:Patients in the VAS group were significantly younger and more likely to have bilateral VA disease (P = 0.04 and P = 0.02). VAS was successfully performed in all ten patients. The periprocedural risk within 30 days was 10% (one TIA). The overall restenosis rate was 10%. One restenosis occurred after 9 months in a patient treated with bare-metal stent. At 4 years of follow-up, VAS showed a nonsignificant trend toward a lower risk for the combined endpoint of TIA and stroke in posterior circulation compared to medical treatment (10% vs. 45%, P = 0.095; relative risk (RR) = 0.24, 95% confidence interval (CI) 0.031-1.85). Patients with bilateral VA disease had a significantly lower recurrence risk after VAS compared with medical treatment (0% vs. 91% at 4 years, P = 0.004; RR 0.10, 95% CI 0.022-0.49) CONCLUSION:VAS was performed without permanent complications in this small series of patients with symptomatic severe OVAS. The long-term benefit seems to be confined to patients with bilateral but not to those with unilateral VA disease.
Authors: K Nedeltchev; L Remonda; D-D Do; C Brekenfeld; C Ozdoba; M Arnold; H P Mattle; G Schroth Journal: Neuroradiology Date: 2004-06-15 Impact factor: 2.804
Authors: Rishi Gupta; Firas Al-Ali; Ajith J Thomas; Michael B Horowitz; Thomas Barrow; Nirav A Vora; Ken Uchino; Maxim D Hammer; Lawerence R Wechsler; Tudor G Jovin Journal: Stroke Date: 2006-09-07 Impact factor: 7.914
Authors: A I Qureshi; J F Kirmani; P Harris-Lane; A A Divani; S Ahmed; A Ebrihimi; A Al Kawi; N Janjua Journal: AJNR Am J Neuroradiol Date: 2006-05 Impact factor: 3.825
Authors: A Compter; H B van der Worp; W J Schonewille; J A Vos; A Algra; T H Lo; W P Th M Mali; F L Moll; L J Kappelle Journal: Trials Date: 2008-11-24 Impact factor: 2.279
Authors: Lucy J Coward; Dominick J H McCabe; Joerg Ederle; Roland L Featherstone; Andrew Clifton; Martin M Brown Journal: Stroke Date: 2007-03-29 Impact factor: 7.914
Authors: Nso Nso; Mahmoud Nassar; Mia Trimingham; Yolanda Mbome; Anthony Lyonga Ngonge; Solomon O Badejoko; Shahzad Akbar; Atika Azhar; Sofia Lakhdar; Muhammad Ghallab; Laura M Guzman Perez; Vincent Rizzo; Most Sirajum Munira Journal: Cureus Date: 2022-05-05
Authors: Hongliang Feng; Yi Xie; Bin Mei; Yang Liu; Benlei Li; Changqing Yin; Tao Wang; Yumin Liu Journal: J Neurol Date: 2016-08-20 Impact factor: 4.849
Authors: Matthew D Alexander; Jeffrey M Rebhun; Steven W Hetts; Matthew R Amans; Fabio Settecase; Robert J Darflinger; Christopher F Dowd; Van V Halbach; Randall T Higashida; Daniel L Cooke Journal: Surg Neurol Int Date: 2017-11-20