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Krassen Nedeltchev - One of the best experts on this subject based on the ideXlab platform.
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Angioplasty Using Drug-Coated Balloons in Ostial Vertebral Artery Stenosis
Annals of Vascular Surgery, 2020Co-Authors: Philipp Gruber, Jatta Berberat, Timo Kahles, Javier Anon, Michael Diepers, Krassen Nedeltchev, Luca RemondaAbstract:Background Ostial Vertebral Artery Stenosis (OVAS) is a relevant cause of acute ischemic posterior circulation stroke. Percutaneous trans-luminal angioplasty (PTA) might offer a promising treatment modality, but reStenosis rate is high. So far, little is known about recanalization using drug-coated balloons (DCB) in OVAS. We aimed to show feasibility and safety of DCB-PTA in OVAS. Methods Retrospective, monocenter case series of 12 patients with ostial Vertebral Artery Stenosis (≥50%) treated with PTA using a drug-coated balloon. Results Median age was 69.5 years (IQR 57–78.5) with a female rate of 41%. Patients were treated either with a SeQuent Please NEO or Neuro Elutax SV DEB. Median preinterventional Stenosis degree was 75% (IQR 70–85) with a median lesion length of 4.5 mm (IQR 4–7.5). Median postinterventional Stenosis degree was 40% (IQR 27–50). All treated vessels remained patent. No major complications such as dissection, vessel perforation, hemorrhage, or ischemic events occurred. Moreover, we did not detect any reStenosis during a median follow-up period of 6.1 months. The clinical outcome was excellent with median mRS scale of 0 (IQR 0–1). Conclusions PTA using drug-coated balloons is feasible and safe in patients with ostial Vertebral Artery Stenosis.
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS)
Neuroradiology, 2010Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale Mordasini, Jan Gralla, Caspar Brekenfeld, Marcel Arnold, Marie-luise Mono, Heinrich Mattle, Krassen NedeltchevAbstract: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.
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS).
Neuroradiology, 2010Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale Mordasini, Jan Gralla, Caspar Brekenfeld, Marcel Arnold, Marie-luise Mono, Heinrich Mattle, D. D., Krassen NedeltchevAbstract: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). 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. 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) 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.
Hugh S. Markus - One of the best experts on this subject based on the ideXlab platform.
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Research data supporting "Stenting for symptomatic Vertebral Artery Stenosis: a preplanned pooled individual patient data analysis"
2019Co-Authors: Hugh S. Markus, Andrew Clifton, Annette Compter, H. Bart Van Der Worp, L. Jaap Kappelle, Eric Harshfield, Wilhelm Küker, Peter M. Rothwell, Ale AlgraAbstract:Excel file containing individual participant data from three randomised controlled trials comparing stenting/angioplasty with medical treatment in patients with Vertebral Artery Stenosis. Individual patient data for VIST and VAST were obtained from the trial investigators, and individual patient data for SAMMPRIS were obtained from the National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke (NINDS) clinical trial data portal (https://clinicaltrials.gov/ct2/show/NCT00576693). A data dictionary is provided within the Excel file that describes the variables contained in the dataset. All personally identifiable information has been removed from the file.
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Stenting for symptomatic Vertebral Artery Stenosis: a preplanned pooled individual patient data analysis
The Lancet Neurology, 2019Co-Authors: Hugh S. Markus, Ale Algra, Andrew Clifton, Annette Compter, H. Bart Van Der Worp, L. Jaap Kappelle, Eric Harshfield, Wilhelm Küker, Peter M. Rothwell, Neil BaldwinAbstract:Summary Background Symptomatic Vertebral Artery Stenosis is associated with a high risk of recurrent stroke, with higher risks for intracranial than for extracranial Stenosis. Vertebral Artery Stenosis can be treated with stenting with good technical results, but whether it results in improved clinical outcome is uncertain. We aimed to compare Vertebral stenting with medical treatment for symptomatic Vertebral Stenosis. Methods We did a preplanned pooled individual patient data analysis of three completed randomised controlled trials comparing stenting with medical treatment in patients with symptomatic Vertebral Stenosis. The primary outcome was any fatal or non-fatal stroke. Analyses were performed for Vertebral Stenosis at any location and separately for extracranial and intracranial stenoses. Data from the intention-to-treat analysis were used for all studies. We estimated hazard ratios (HRs) with 95% CIs using Cox proportional-hazards regression models stratified by trial. Findings Data were from 354 individuals from three trials, including 179 patients from VIST (148 with extracranial Stenosis and 31 with intracranial Stenosis), 115 patients from VAST (96 with extracranial Stenosis and 19 with intracranial Stenosis), and 60 patients with intracranial Stenosis from SAMMPRIS (no patients had extracranial Stenosis). Across all trials, 168 participants (46 with intracranial Stenosis and 122 with extracranial Stenosis) were randomly assigned to medical treatment and 186 to stenting (64 with intracranial Stenosis and 122 with extracranial Stenosis). In the stenting group, the frequency of periprocedural stroke or death was higher for intracranial Stenosis than for extracranial Stenosis (ten (16%) of 64 patients vs one (1%) of 121 patients; p Interpretation Stenting for Vertebral Stenosis has a much higher risk for intracranial, compared with extracranial, Stenosis. This pooled analysis did not show evidence of a benefit for stroke prevention for either treatment. There was no evidence of benefit of stenting for intracranial Stenosis. Stenting for extracranial Stenosis might be beneficial, but further larger trials are required to determine the treatment effect in this subgroup. Funding None.
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Stenting for symptomatic Vertebral Artery Stenosis: The Vertebral Artery Ischaemia Stenting Trial.
Neurology, 2017Co-Authors: Hugh S. Markus, Wilhelm Küker, Peter M. Rothwell, Susanna C. Larsson, Ursula G. Schulz, Ian Ford, Andrew CliftonAbstract:Objective: To compare in the Vertebral Artery Ischaemia Stenting Trial (VIST) the risks and benefits of Vertebral angioplasty and stenting with best medical treatment (BMT) alone for symptomatic Vertebral Artery Stenosis. Methods: VIST was a prospective, randomized, open-blinded endpoint clinical trial performed in 14 hospitals in the United Kingdom. Participants with symptomatic Vertebral Stenosis ≥50% were randomly assigned (1:1) to Vertebral angioplasty/stenting plus BMT or to BMT alone with randomization stratified by site of Stenosis (extracranial vs intracranial). Because of slow recruitment and cessation of funding, recruitment was stopped after 182 participants. Follow-up was a minimum of ≥1 year for each participant. Results: Three patients did not contribute any follow-up data and were excluded, leaving 91 patients in the stent group and 88 in the medical group. Mean follow-up was 3.5 (interquartile range 2.1–4.7) years. Of 61 patients who were stented, Stenosis was extracranial in 48 (78.7%) and intracranial in 13 (21.3%). No periprocedural complications occurred with extracranial stenting; 2 strokes occurred during intracranial stenting. The primary endpoint of fatal or nonfatal stroke occurred in 5 patients in the stent group vs 12 in the medical group (hazard ratio 0.40, 95% confidence interval 0.14–1.13, p = 0.08), with an absolute risk reduction of 25 strokes per 1,000 person-years. The hazard ratio for stroke or TIA was 0.50 ( p = 0.05). Conclusions: Stenting in extracranial Stenosis appears safe with low complication rates. Large phase 3 trials are required to determine whether stenting reduces stroke risk. ISRCTN.com identifier: ISRCTN95212240. Classification of evidence: This study provides Class I evidence that for patients with symptomatic Vertebral Stenosis, angioplasty with stenting does not reduce the risk of stroke. However, the study lacked the precision to exclude a benefit from stenting.
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Imaging of Vertebral Artery Stenosis: a systematic review
Journal of Neurology Neurosurgery & Psychiatry, 2007Co-Authors: Sofia Khan, Geoffrey Cloud, Sally Kerry, Hugh S. MarkusAbstract:Background and purpose: Posterior circulation stroke accounts for 20% of ischaemic strokes. Recent data suggest that the early stroke recurrence risk is high and comparable with carotid Artery disease. Vertebral Artery Stenosis accounts for approximately 20% of posterior circulation stroke, and with endovascular treatment available accurate diagnostic imaging is important. We performed a systematic literature review to validate the accuracy of the non-invasive imaging techniques Duplex ultrasound (DUS), magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) in detecting severe Vertebral Artery Stenosis, with intra-arterial angiography (IAA) as the reference standard. Methods: We identified studies that used non-invasive imaging and IAA as the reference standard to determine Vertebral Artery Stenosis and provided adequate data to calculate sensitivity and specificity. We analysed the quality of these studies, looked for evidence of heterogeneity and performed subgroup analysis for different degrees of Stenosis. Results: 11 studies categorised Stenosis into 50–99%. The sensitivity of CTA (single study) and pooled sensitivities of contrast enhanced MRA (CE-MRA) and colour duplex were 100% (95% CI 15.8 to 100), 93.9% (79.8 to 99.3) and 70.2% (54.2 to 83.3), respectively. The specificities for CTA, CE-MRA and colour duplex were 95.2% (83.8 to 99.4), 94.8% (91.1 to 97.3) and 97.7% (95.2 to 99.1). However, specificities for CE-MRA and colour duplex demonstrated significant heterogeneity (p = 0.003 and p = 0.002, respectively). Conclusions: CE-MRA and possibly CTA may be more sensitive in diagnosing Vertebral Artery Stenosis than DUS. However, data are limited and further high quality studies comparing DUS, MRA and CTA with IAA are required.
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Vertebral Artery Stenosis
Current Treatment Options in Cardiovascular Medicine, 2004Co-Authors: Geoffrey C. Cloud, Hugh S. MarkusAbstract:Stenosis of the Vertebral Artery (VA) in either its extra- or intracranial portions is an important cause of posterior circulation stroke. Diagnosis of VA Stenosis by noninvasive imaging techniques is improving and new endovascular and medical treatments are now available. However, the natural history of VA stenotic lesions is not known and its optimum management is unclear. Symptomatic VA Stenosis should be initially treated with established antiplatelet agents. There is no proven indication for anticoagulation in cases of VA Stenosis. Case series have shown that angioplasty and stenting for proximal extracranial VA Stenosis have a low perioperative complication rate and are effective in restoring luminal diameter. Evidence from randomized trials on its long-term efficacy versus medical therapy is not available. Regarding current evidence where symptoms are refractory to antiplatelet treatment, or where recurrent stroke risk is considered increased due to either an incomplete circle of Willis or an anomalous VA circulation, it can be considered in centers with experience of the procedure. Randomized trials comparing stenting with medical therapy are required. Surgery may be a viable alternative to angioplasty and stenting, but only in a few specialist centers. Evidence from randomized controlled trials of medical and other interventions for VA Stenosis are required.
Alexander Karameshev - One of the best experts on this subject based on the ideXlab platform.
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS)
Journal of Vascular Surgery, 2011Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale MordasiniAbstract: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).
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS)
Neuroradiology, 2010Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale Mordasini, Jan Gralla, Caspar Brekenfeld, Marcel Arnold, Marie-luise Mono, Heinrich Mattle, Krassen NedeltchevAbstract: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.
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS).
Neuroradiology, 2010Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale Mordasini, Jan Gralla, Caspar Brekenfeld, Marcel Arnold, Marie-luise Mono, Heinrich Mattle, D. D., Krassen NedeltchevAbstract: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). 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. 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) 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.
Pasquale Mordasini - One of the best experts on this subject based on the ideXlab platform.
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS)
Journal of Vascular Surgery, 2011Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale MordasiniAbstract: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).
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS)
Neuroradiology, 2010Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale Mordasini, Jan Gralla, Caspar Brekenfeld, Marcel Arnold, Marie-luise Mono, Heinrich Mattle, Krassen NedeltchevAbstract: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.
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS).
Neuroradiology, 2010Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale Mordasini, Jan Gralla, Caspar Brekenfeld, Marcel Arnold, Marie-luise Mono, Heinrich Mattle, D. D., Krassen NedeltchevAbstract: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). 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. 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) 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.
Gerhard Schroth - One of the best experts on this subject based on the ideXlab platform.
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS)
Journal of Vascular Surgery, 2011Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale MordasiniAbstract: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).
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS)
Neuroradiology, 2010Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale Mordasini, Jan Gralla, Caspar Brekenfeld, Marcel Arnold, Marie-luise Mono, Heinrich Mattle, Krassen NedeltchevAbstract: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.
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Long-term outcome of symptomatic severe ostial Vertebral Artery Stenosis (OVAS).
Neuroradiology, 2010Co-Authors: Alexander Karameshev, Gerhard Schroth, Pasquale Mordasini, Jan Gralla, Caspar Brekenfeld, Marcel Arnold, Marie-luise Mono, Heinrich Mattle, D. D., Krassen NedeltchevAbstract: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). 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. 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) 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.