Long-term outcome of symptomatic severe ostial vertebral artery stenosis (OVAS).
BACKGROUND
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)


CONCLUSIONS
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.
Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, 3010, Bern, Switzerland.
Alexander
A
Karameshev
Gerhard
G
Schroth
Pasquale
P
Mordasini
Jan
J
Gralla
Caspar
C
Brekenfeld
Marcel
M
Arnold
Marie-Luise
ML
Mono
Heinrich P
HP
Mattle
Do-Dai
DD
Do
Krassen
K
Nedeltchev
D000367:Age Factors; D000368:Aged; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000187:drug effects / Q000473:pathology; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D012008:Recurrence; D012306:Risk; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy*