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

Karameshev, Alexander ; Schroth, Gerhard ; Mordasini, Pasquale ; Gralla, Jan ; Brekenfeld, Caspar ; Arnold, Marcel ; Mono, Marie-Luise ; Mattle, Heinrich P. ; Do, Do-Dai ; Nedeltchev, Krassen

In: Neuroradiology, 2010, vol. 52, no. 5, p. 371-379

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    Summary
    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 2.8years. 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 30days was 10% (one TIA). The overall restenosis rate was 10%. One restenosis occurred after 9months in a patient treated with bare-metal stent. At 4years 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 4years, 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