Long-Term Outcome After Angioplasty and Stenting for Symptomatic Vertebral Artery Stenosis Compared With Medical Treatment in the C arotid A nd V ertebral A rtery T ransluminal A ngioplasty S tudy (CAVATAS)

Abstract

on behalf of the CAVATAS Investigators* Background and Purpose-The long-term outcome of endovascular intervention compared with best medical management of patients with symptomatic vertebral artery stenosis is uncertain. We therefore compared these treatments in a randomized trial with long-term follow-up. Methods-In the international, multicenter Carotid And Vertebral Artery Transluminal Angioplasty Study, 16 patients with symptomatic vertebral artery stenosis were randomized in equal proportions to receive endovascular therapy (balloon angioplasty or stenting) or best medical treatment alone. An independent neurologist followed up the patients for as long as 8 years. Results-Endovascular intervention was technically successful in all 8 patients, but 2 patients experienced transient ischemic attack at the time of endovascular treatment. There were no deaths or strokes in any arterial territory within the first 30 days. During a mean follow-up period of 4.7 years, no patient in either treatment group experienced a vertebrobasilar territory stroke, but 3 patients in each treatment arm died of myocardial infarction or carotid territory stroke, and 1 endovascular patient had a nonfatal carotid territory stroke. Conclusions-Patients with vertebral artery stenosis were more likely to have carotid territory stroke and myocardial infarction during follow-up than have recurrent vertebrobasilar stroke. The trial failed to show a benefit of endovascular treatment of vertebral artery stenosis, but the numbers of patients included was small. Larger randomized trials are required to determine whether vertebral artery stenting is justified in patients at higher risk of vertebrobasilar stroke. Treatment of patients with vertebral artery stenosis should focus on global reduction of vascular risk, including prevention of carotid territory stroke and myocardial infarction.

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

“…The only RCT to compare outcomes after endovascular treatment versus optimal medical treatment alone among patients with ECVAS is CAVATAS. 378 In that trial, which enrolled patients with either carotid or vertebral artery stenosis, just 16 subjects with symptoms in the vascular territory supplied by a stenosed vertebral artery were randomized to receive either endovascular therapy (angioplasty or stenting) or medical management alone and followed up for a mean of 4.7 years. In the endovascular group, 6 patients underwent percutaneous transluminal angioplasty alone, and 2 had stenting.…”

Pearls and Oy-sters: Reversible iatrogenic Balint syndrome

“…Although there are currently no data that vertebral artery stenting provides better long-term outcomes than medical therapy (anticoagulation or antiplatelet agents), it is a technically feasible procedure that offers an alternative to more technically challenging vertebral artery endarterectomies. 10,11 This case highlights the possibility of coexistent intracranial stenoses and cerebral dysautoregulation in patients with coronary disease and the need for caution when administering nitroglycerin to such patients. …”

Angioplasty and Stenting of Symptomatic Vertebral Artery Stenosis Clinical and Angiographic Follow-up of 206 Cases from Northwest Iran

“…Stenosis severity was calculated according to the carotid stenosis method proposed in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) and was classified as mild (0% to 49%), moderate (50% to 69%), severe (70% to 99%), or occluded [21][22][23] . Aortic arch, renal artery angiography and four-vessel digital subtraction angiography (DSA) were performed to evaluate extra and intracranial arteries in all patients.…”