A Retrospective Study Comparison Between Stenting and Standardized Medical Treatment for Intracranial Vertebrobasilar Stenosis in a Real-World Chinese Cohort

Li, Guanzeng; Yan, Peng; Zhao, Yuanyuan; Li, Shan; Xue, Yuan; Xiang, Yuanyuan; Liu, Xiaohui; Li, Jifeng; Sun, Qinjian

doi:10.3389/fneur.2021.629644

Cited by 2 publications

(1 citation statement)

References 25 publications

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“…Based on that, stenting management is preferred recommendation in patient with symptomatic vertebrobasilar artery stenosis. In terms of higher risk of stroke recurrence in vertebrobasilar artery stenosis, more advanced management for better curative and preventive strategies need to be evaluated 13,14 .…”

Section: Discussionmentioning

confidence: 99%

Intracranial and Extracranial Vertebrobasilar Artery Stenosis Patient Profile in Dr. Moewardi General Hospital

Subandi,

Suroto,

Mirawati

et al. 2024

SMedJour

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Introduction: Vertebrobasilar artery stenosis can be extracranial or intracranial, and accounts for up to 20% of posterior circulation ischemic strokes. The gold standard for diagnosing is Digital Subtraction Angiography (DSA), an invasive diagnostic method by injecting a contrast agent into the blood vessels leading to the brain through a catheter. This study aims to determine the profile of patients with intracranial and extracranial vertebrobasilar artery stenosis who underwent DSA procedures.Methods: This descriptive research was conducted in RSUD Dr. Moewardi in patients who underwent DSA procedures for the period January 2020 to March 2022 and found vertebrobasilar artery stenosis. The study samples were grouped based on the location of the stenosis; intracranial and extracranial. The data collected included age, gender, symptoms, risk factors, degree of stenosis, and angiographic findings.Results: Of 42 subjects, 33 (78.6%) patients were male. There are 23 (54.8%) patients with intracranial vertebrobasilar stenosis and 19 (45.2%) patients in extracranial. The main symptoms included hemiparesis, vertigo, hemiesthesia, loss of consiciousness, aphasia, dysartria, and dysphagia. The risk factors were 36 (85.7%) patients with hypertension, 18 (42.9%) patients with diabetes mellitus, 18 (42.9%) patients with a history of smoking, and 13 (31%) patients with hyperlipidemia. A total of 8 patients underwent stenting/angioplasty.Conclusion: The prevalence of vertebrobasilar artery stenosis increases with age, most commonly occurring at the age of 50-59 years..The most common risk factor for vertebrobasilar artery stenosis is hypertension. Management recommendations include a combination of antiplatelet and endovascular therapy.

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Section: Discussionmentioning

confidence: 99%

Intracranial and Extracranial Vertebrobasilar Artery Stenosis Patient Profile in Dr. Moewardi General Hospital

Subandi,

Suroto,

Mirawati

et al. 2024

SMedJour

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Percutaneous transluminal angioplasty and stenting (PTAS) in patients with symptomatic intracranial vertebrobasilar artery stenosis (IVBS)

Pourahmad,

Saleki,

Zoghi

et al. 2024

Stroke Vasc Neurol

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Background Approximately 20% of all transient ischaemic attacks (TIAs) and ischaemic strokes occur within the posterior circulation, with vertebrobasilar stenosis identified as the cause in roughly 25% of the cases. Studies have shown that about a quarter of these patients have atherosclerotic stenosis of at least 50% of the vertebrobasilar artery. Stenosis has been shown to be associated with an increased risk of 90-day recurrent vertebrobasilar stroke, particularly in the first few weeks, which is significantly higher when compared with patients with stenosis of the anterior circulation. Therefore, aggressive treatment is important for the patient’s prognosis. Stenting is emerging as a promising therapeutic strategy for persistent ischaemia events that do not respond to the best medical treatment, but it is not without complications. We systematically reviewed the literature on percutaneous transluminal angioplasty and stenting (PTAS) for intracranial vertebrobasilar artery stenosis (IVBS). Methods PubMed, Web-of-Science and Scopus were searched upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to include prospective/retrospective cohort, randomised/non-randomised clinical trials and case series studies describing PTAS for IVBS. Pooled rates of intervention-related complications and outcomes were analysed with random-effect model meta-analysis using StataMP V.18.0 software. Results 31 studies were found eligible which included 1928 cases. 1103 basilar artery stenosis cases were reported in 27 studies 0.65 (95% CI 0.53, 0.76), I2: 99.72%. 648 vertebral cases were reported in 18 studies 0.60 (95% CI 0.49, 0.70), I2: 97.49%. In four studies, the rate of vertebrobasilar stenosis cases calculated as a proportion of the total sample size was 0.10 (95% CI 0.05, 0. 15). Mean stenosis in 21 included studies was found to be 0.83 (95% CI 0.79, 0.88), I2: 0.00%, which shows variation of baseline stenosis between studies was minimal. 51 deaths were recorded in 24 studies. Meta-analysis of mortality showed the overall rate of mortality was 0.03 (95% CI 0.02, 0.05), I2: 44.90%. In 14 studies, symptomatic intracranial haemorrhage events were recorded at an overall rate of 0.01 (95% CI 0.00, 0.02), I2: 0.00%. Generally, a follow-up period of at least 3 months was reported in the included studies. Furthermore, procedural stroke/TIA was evaluated in seven studies, four of which reported no events (0.03 (95% CI 0.00, 0.08), I2: 20.38%). Mean time from initial symptoms to recanalisation was 23.98 (95% CI 18.56, 29.40), I2=98.8%, p=0.00 days. Conclusion In certain individuals with medically unresolved, severe, symptomatic and non-acute IVBS, elective vertebrobasilar PTAS appears to be both safe and effective. Various stent designs and angioplasty-assisted techniques should be taken into consideration based on the specific clinical and radiological traits of the lesions. Future randomised controlled trials are required to verify these results.

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A Retrospective Study Comparison Between Stenting and Standardized Medical Treatment for Intracranial Vertebrobasilar Stenosis in a Real-World Chinese Cohort

Cited by 2 publications

References 25 publications

Intracranial and Extracranial Vertebrobasilar Artery Stenosis Patient Profile in Dr. Moewardi General Hospital

Intracranial and Extracranial Vertebrobasilar Artery Stenosis Patient Profile in Dr. Moewardi General Hospital

Percutaneous transluminal angioplasty and stenting (PTAS) in patients with symptomatic intracranial vertebrobasilar artery stenosis (IVBS)

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