title: Transluminal angioplasty and stenting versus conservative treatment in patients with symptomatic basilar artery stenosis : Perspective for future clinical trials.
abstract: OBJECTIVE
  Two recent randomized controlled trials (RCT) consistently showed superiority of aggressive medical treatment versus percutaneous transluminal angioplasty and stenting (PTAS) in patients with intracranial artery stenosis. Patients with symptomatic basilar stenosis have a higher long-term risk of recurrent stroke compared to patients with anterior circulation stenosis but no study has specifically focused on the role of PTAS in this subgroup. The aim of our study was to investigate the subgroup of patients with symptomatic basilar artery stenosis to find evidence for the feasibility of a future clinical trial.
  
  
  METHODS
  Patients with ischemic stroke caused by a symptomatic basilar stenosis and admitted to five German tertiary care hospitals were included in this multicenter effectiveness study. Primary outcome was a composite endpoint of stroke recurrence, clinically relevant restenosis, progression and death. Shared frailty Cox regression models were used to compare outcome rates between groups.
  
  
  RESULTS
  Of the 139 patients included in the study 79 (57 %) underwent PTAS and 60 (43 %) conservative treatment alone. The median follow-up period was 300 (IQR 18-738) days. Risks of the primary composite outcome (hazard ratio HR 0.49, 95 % confidence interval CI 0.25-0.97, p = 0.039) and of the key secondary outcomes recurrent stroke (HR 0.42, 95 % CI 0.19-0.95, p = 0.037) and clinically relevant restenosis/progression (HR 0.12, 95 % CI 0.03-0.59, p = 0.009) were lower in patients with PTAS compared to conservative treatment. There was no difference in all-cause mortality between groups (HR 0.98, 95 % CI 0.19-5.09, p = 0.979).
  
  
  CONCLUSIONS
  In this retrospective study we could not reproduce the findings from large RCTs on intracranial stenting. Our data could be considered as a basis for a prospective study on patient selection for PTAS in the basilar artery.
authors: Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. ilko.maier@med.uni-goettingen.de.
authors: Ilko L
authors: IL
authors: Maier
authors: Research group Epidemiological and Statistical Methods (ESME), Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.
authors: André
authors: A
authors: Karch
authors: Department of Neuroradiology, University Medicine Göttingen, Göttingen, Germany.
authors: Christina
authors: C
authors: Lipke
authors: Department of Neuroradiology, University Medicine Göttingen, Göttingen, Germany.
authors: Daniel
authors: D
authors: Behme
authors: Department of Neuroradiology, University Hospital Cologne, Cologne, Germany.
authors: Anastasios
authors: A
authors: Mpotsaris
authors: Department of Neuroradiology, University Hospital Cologne, Cologne, Germany.
authors: Christoph
authors: C
authors: Kabbasch
authors: Department of Neuroradiology, University Hospital Cologne, Cologne, Germany.
authors: Thomas
authors: T
authors: Liebig
authors: Department of Neurosurgery, University Hospital Cologne, Cologne, Germany.
authors: Andrea
authors: A
authors: Faymonville
authors: Department of Neurology, University Hospital Aachen, Aachen, Germany.
authors: Arno
authors: A
authors: Reich
authors: Department of Neuroradiology, University Hospital Aachen, Aachen, Germany.
authors: Omid
authors: O
authors: Nikoubashman
authors: Department of Neuroradiology, , University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany.
authors: Jan-Hendrik
authors: JH
authors: Buhk
authors: Department of Neuroradiology, Klinikum Vest, Recklinghausen, Germany.
authors: Patrick
authors: P
authors: von Schoenfeld
authors: Department of Neuroradiology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany.
authors: Werner
authors: W
authors: Weber
authors: Research group Epidemiological and Statistical Methods (ESME), Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.
authors: Rafael T
authors: RT
authors: Mikolajczyk
authors: Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
authors: Mathias
authors: M
authors: Bähr
authors: Department of Neuroradiology, University Medicine Göttingen, Göttingen, Germany.
authors: Michael
authors: M
authors: Knauth
authors: Department of Neuroradiology, University Medicine Göttingen, Göttingen, Germany.
authors: Kai
authors: K
authors: Kallenberg
authors: Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. jliman@gwdg.de.
authors: Jan
authors: J
authors: Liman
mesh_terms: D000368:Aged; D017130:Angioplasty; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000628:therapy*
keywords: Basilar artery; Conservative therapy; Ischemic stroke; Stent; Stroke outcome