Stenting for symptomatic vertebral artery stenosis: a preplanned pooled individual patient data analysis

Markus, Hugh S.; Harshfield, Eric L.; Compter, Annette; Küker, Wilhelm; Kappelle, L. Jaap; Clifton, Andrew; Worp, H. Bart van der; Rothwell, Peter M.; Algra, Ale; Baldwin, Neil; Bradley, Marcus; Brew, Stefan; Crossley, Robert; Dixit, Anand; Emsley, Hedley; Ford, Ian; Gaines, Peter A.; Gholkhar, Anil; Goddard, Anthony; Hampton, Tim; Hassan, Ahamad; Higgins, Nick; Larsson, Susanna C.; Lindert, Ralf-Bjoern; Lo, T.H.; Madigan, Jeremy; Mali, Willem P.Th.M.; Moll, Frans L.; Moynihan, Barry; Nahser, H. C.; Nayak, Sanjeev; Patel, Maneesh C.; Piechowski-Jóźwiak, Bartłomiej; Raghunathan, Senthil; Roffe, Christine; Schonewille, Wouter J.; Schulz, Ursula G.; Sekhar, Alakendu; Sharma, Pankaj; Vos, Jan Albert; Werring, David J.; Wuppalapati, Siddhartha

doi:10.1016/s1474-4422(19)30149-8

Cited by 49 publications

(23 citation statements)

References 18 publications

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“…All three cases of cerebral hemorrhage in the PTAS group occurred within 7 days after the surgery. In PTAS, the increased risk of rupture may be due to the following: (1) the thin wall of the intracranial arteries ( 21); (2) the intracranial arteries located in the cerebrospinal fluid of the subarachnoid cavity with no tissue around them; (3) the perforating arteries of the intracranial arteries and the possible damage of these arteries during stent placement (22); and (4) the experience of the operator is another important factor that affects the outcome of stent therapy. To reduce the risk of stroke recurrence or death, the technology needs to be improved based on the above characteristics in the future.…”

Section: Discussionmentioning

confidence: 99%

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

Yan

Zhao

et al. 2021

Front. Neurol.

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Background: To date, there has been no consensus regarding the benefits of percutaneous transluminal angioplasty and stenting (PTAS) vs. those of standardized medical treatment (SMT) for patients with symptomatic intracranial vertebrobasilar stenosis (IVBS). The purpose of this retrospective study was to compare the effects of PTAS or SMT on symptomatic IVBS in a real-world Chinese population.Methods: We included 238 patients with ischemic stroke caused by IVBS stenosis who were admitted to Shandong Provincial Hospital Affiliated to Shandong University between September 2012 and May 2018; 62 of these patients were treated with SMT and 176 underwent PTAS. Ischemic stroke in the territory of the responsible artery, hemorrhage, and death within 1 year were recorded as primary endpoints. Secondary endpoints included assessment of stroke severity and the incidence of re-stenosis. The primary endpoint rates were compared between the PTAS and SMT groups at 7 days, 1, 6 months, and 1 year.Results: In the PTAS group, the success rate of stent placement was 98.9%. During the entire trial, except for 7 days, the SMT group had a higher frequency of primary endpoint events than did the PTAS group. The primary endpoint was 17.7% (11/62) vs. 8.6% (15/174) at 1 month (p = 0.049), 29% (18/62) vs. 14.4% (25/174) at 6 months (p = 0.01), and 32.2% (20/62) vs. 17.2% (30/174) at 1 year (p = 0.013). The restenosis rate of the target lesion was 13.8%; 60% were symptomatic restenosis and 40% were asymptomatic restenosis. The rate of severe stroke at 1 year after PTAS was 0%, while that in the SMT group was 9.7%.Conclusions: In a real-world Chinese cohort, PTAS for patients might be superior to SMT, and provide better long-term neurological function recovery and lower disability rate.

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Section: Discussionmentioning

confidence: 99%

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

Yan

Zhao

et al. 2021

Front. Neurol.

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“…Furthermore, an analysis including data from SAMMP-RIS and from two more recent RCTs dedicated to vertebral artery stenosis (VAST and VIST) 14,13 did not show evidence of benefit in stroke prevention for either medical or endovascular treatment in SIVBS. 26 In point of fact, the number of patients with SIVBS who received endovascular treatment in these RCTs is low (only 36 patients in SAMMPRIS, 13 in VIST, and 9 in VAST). An analogous meta-analysis including 23 studies showed that risk of stroke recurrence or death is comparable between medical and endovascular treatment in patients with SIVBS.…”

Section: Patient Selectionmentioning

confidence: 93%

“…Similar or worse results have been reported by the meta-analysis by Markus et al and Abuzinadah et al: for posterior circulation intracranial stent placement, they reported a peri-procedural stroke and death rate of 16% and 6,5% respectively. 26,27…”

Section: Early Outcomesmentioning

confidence: 99%

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Endovascular Treatment of Symptomatic Intracranial Vertebrobasilar Stenosis: A 10-Year Single Centre Experience Using Balloon-Expandable Coronary Artery Stents

Piano

Milonia

Cervo

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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“…It is important to know whether endovascular therapy can reduce the risk of recurrent stroke. The role of angioplasty and stenting based on the stenosis diameter in the intracranial artery is unclear 4–7. A previous study showed that the stroke recurrence risk is associated with features of vulnerable plaque rather than the diameter of the stenosis 8.…”

Section: Introductionmentioning

confidence: 99%

Optical coherence tomography evaluation of vertebrobasilar artery stenosis: case series and literature review

et al. 2020

J NeuroIntervent Surg

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BackgroundIntracranial vertebrobasilar artery stenosis is an important cause of ischemic stroke. With its high resolution, intravascular optical coherence tomography (OCT) provides detailed assessment of vessel wall features. It is widely applied to identify high-risk plaque in the cardiovascular system, but its use in the intracranial artery has been limited.ObjectiveTo explore, in this pilot study, the usefulness of OCT in imaging of the intracranial artery wall.MethodsBetween November 2017 and July 2018, four patients with severe intracranial vertebrobasilar artery stenosis were enrolled for preintervention OCT evaluation of the lesion artery. Stenosis was present in the basilar artery in one case and in the intracranial vertebral artery in three cases.ResultsOCT images of the lesions showed various features of plaque vulnerability, such as intraluminal thrombus, lipid-rich plaque with plaque rupture, thin fibrous cap, macrophage accumulations, and a mixed lesion with dissecting aneurysm. In view of the OCT findings, all patients received balloon angioplasty and stent implantation.ConclusionsThese cases describe the successful implementation of OCT in intracranial vertebrobasilar artery stenosis. No side effects were seen during the OCT imaging. This technology may help in the diagnosis and treatment of cerebrovascular disease.

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Stenting for symptomatic vertebral artery stenosis: a preplanned pooled individual patient data analysis

Cited by 49 publications

References 18 publications

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

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

Endovascular Treatment of Symptomatic Intracranial Vertebrobasilar Stenosis: A 10-Year Single Centre Experience Using Balloon-Expandable Coronary Artery Stents

Optical coherence tomography evaluation of vertebrobasilar artery stenosis: case series and literature review

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