title: The natural history of vertebral artery origin stenosis.
abstract: BACKGROUND
  We sought to determine the long-term survival and natural history of vertebral artery origin stenosis (VAOS) as it relates to stroke.
  
  
  METHODS
  We retrospectively reviewed clinical data on patients admitted at a single institution for possible stroke between 2004 and 2007 and selected subjects who underwent angiography of the neck. We classified VAOS subjects as having "moderate" to "severe" (≥50%) occlusion. Age-, sex-, and race-matched control subjects with no evidence of VAOS on angiography were selected from our study population. Long-term follow-up data were collected and death certificates were searched for comparison among cases and controls. A Kaplan-Meier curve was plotted based on time to event (stroke or death).
  
  
  RESULTS
  Fifty-eight of the 358 subjects were found to have VAOS (16.2%). Four subjects were excluded because of stenting; therefore, 54 cases and 54 matched controls were included for long-term follow-up analysis. In our study population, we calculated that the relative risk of having a stroke or dying in patients with VAOS was 6 times that of patients without VAOS (P < .02). The observed 5-year survival rate for patients with VAOS was 67% (36/54) compared to 89% (48/54) in control subjects (P < .01).
  
  
  CONCLUSIONS
  Patients with VAOS are at a significantly higher risk of having a stroke or dying. Subsequent prospective, multicenter studies are needed to validate our results.
authors: Departments of Neurology, Neurosurgery, and Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
authors: Matthew C
authors: MC
authors: Thompson
authors: Departments of Neurology, Neurosurgery, and Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
authors: Mohammad A
authors: MA
authors: Issa
authors: Departments of Neurology, Neurosurgery, and Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
authors: Marc A
authors: MA
authors: Lazzaro
authors: Departments of Neurology, Neurosurgery, and Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin. Electronic address: szaidat@mcw.edu.
authors: Osama O
authors: OO
authors: Zaidat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000473:pathology; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000473:pathology; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
keywords: Cerebrovascular disease; computed tomographic angiogram; natural history study; vertebral artery origin stenosis