One-Year Risk of Recurrent Stroke and Death Associated with Vertebrobasilar Artery Stenosis and Occlusion in a Cohort of 10,515 Patients

Abstract

Background: The natural history of vertebrobasilar artery (VBA) stenosis or occlusion remains understudied. Methods: Patients with diagnosis of ischemic stroke or transient ischemic attack (TIA) who were noted to have VBA stenosis based on computed tomography or magnetic resonance imaging or catheter-based angiogram were selected from Taiwan Stroke Registry. Cox proportional hazards model was used to determine the hazards ratio (HR) of recurrent stroke and death within 1 year of index event in various groups based on severity of VBA stenosis (none to mild: 0–49%; moderate to severe: 50–99%: occlusion: 100%) after adjusting for differences in demographic and clinical characteristics between groups at baseline evaluation. Results: None to mild or moderate to severe VBA stenosis was diagnosed in 6972 (66%) and 3,137 (29.8%) among 10,515 patients, respectively, and occlusion was identified in 406 (3.8%) patients. Comparing with patients who showed none to mild stenosis of VBA, there was a significantly higher risk of recurrent stroke (HR 1.21, 95% CI 1.01–1.45) among patients with moderate to severe VBA stenosis. There was a nonsignificantly higher risk of recurrent stroke (HR 1.49, 95% CI 0.99–2.22) and significantly higher risk of death (HR 2.21, 95% CI 1.72–2.83), among patients with VBA occlusion after adjustment of potential confounders. Conclusions: VBA stenosis or occlusion was relatively prevalent among patients with TIA or ischemic stroke and associated with higher risk of recurrent stroke and death in patients with ischemic stroke or TIA who had large artery atherosclerosis.

Collateral Flow in Magnetic Resonance Angiography: Prognostic Value for Vertebrobasilar Stenosis With Stroke Recurrence

“…No difference in the rate of recurrent ischemic stroke or death was observed between patients with 50%–99% and 0%–49% stenosis of the vertebrobasilar artery. 22 …”

Mid-Term Results of Left Carotid-Subclavian Bypass in Patients Undergoing Zone 2 TEVAR

“…The prevalence of PICA variation is about 4-5% [ 7 ] . Thus, losing the PICA blood supply causes a high risk of vertebrobasilar ischemic stroke (6.4%) [ 8 ] . Therefore, we performed LSA revascularization with open surgery (LSA-CSB bypass) or endovascular techniques (chimney or periscope) or by placing a physician-modified fenestrated TEVAR graft to protect the LSA blood flow in all our TEVAR patients, either elective or urgent, if the patient was eligible.…”

Risk of Recurrence of Symptomatic Intracranial Atherosclerosis in Posterior Circulation Seen to Be Higher Than That in Anterior Circulation in Long-Term Follow-Up

“…A stroke registration study on a Taiwanese population pointed that the increased degree of vertebrobasilar artery (VBA) stenosis was associated with stroke recurrence. The 1-year stroke recurrence risk of patients with moderate-to-severe VBA stenosis was 1.21-times higher than that of patients with mild VBA stenosis [95% CI (1.01-1.45), p < 0.05] (20). Patients with basilar artery stenosis had a higher risk of recurrent stroke than those with vertebral artery stenosis according to a meta-analysis (21).…”