Transluminal angioplasty and stenting versus conservative treatment in patients with symptomatic basilar artery stenosis
- 9 August 2016
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical Neuroradiology
- Vol. 28 (1), 33-38
- https://doi.org/10.1007/s00062-016-0528-x
Abstract
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. 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. 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). 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.Keywords
This publication has 17 references indexed in Scilit:
- Stenting versus Aggressive Medical Therapy for Intracranial Arterial StenosisNew England Journal of Medicine, 2011
- Design of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis TrialJournal Of Stroke & Cerebrovascular Diseases, 2011
- Vertebrobasilar Stenosis Predicts High Early Recurrent Stroke Risk in Posterior Circulation Stroke and TIAStroke, 2009
- Incidence and prognosis of >=50% symptomatic vertebral or basilar artery stenosis: prospective population-based studyBrain, 2008
- Comparison of Warfarin and Aspirin for Symptomatic Intracranial Arterial StenosisNew England Journal of Medicine, 2005
- New England medical center posterior circulation registryAnnals of Neurology, 2004
- Atherosclerotic Occlusive Extracranial Vertebral Artery Disease:Journal of Interventional Cardiology, 2004
- Prognosis of vertebrobasilar transient ischaemic attack and minor strokeBrain, 2003
- Stroke-free Survival and Its Determinants in Patients with Symptomatic Vertebrobasilar Stenosis: A Multicenter StudyNeurosurgery, 2003
- Diagnosis and management of vertebral artery stenosisQJM: An International Journal of Medicine, 2003