Stroke recurrence rates among patients with symptomatic intracranial vertebrobasilar stenoses: systematic review and meta-analysis

Abuzinadah, Ahmad R.; Alanazy, Mohammed H.; Almekhlafi, Mohammed; Duan, Yanjune; Zhu, Haifeng; Mazighi, Mikaël; Lutsep, Helmi L.; Donnon, Tyrone; Hill, Michael D.

doi:10.1136/neurintsurg-2014-011458

Cited by 38 publications

(39 citation statements)

References 34 publications

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“…Antiplatelet function testing by thromboelastography revealed no abnormalities. The 30-day stroke and mortality rate in our study was 5.2%, similar to the 6.3% from Jiang's study on intracranial posterior circulation stenting [10] and the 6.5% from a meta-analysis [4]. It was lower than the 14.7% of the endovascular arm in SAMMPRIS [2] and the rate of 10.8-13.8% from a review of published studies of intervention for the intracranial vertebrobasilar system [16].…”

Section: Discussionsupporting

confidence: 84%

“…Although the controversial SAMMPRIS study did not demonstrate superiority of endovascular treatment over medical treatment, most of the ischemic events in SAMMPRIS and in a recent meta-analysis of intracranial vertebrobasilar intervention occurred perioperatively [3,4]. These results can be interpreted as a low perioperative risk being imperative to improve the risk-benefit ratio of endovascular treatment over medical treatment.…”

Section: Introductionmentioning

confidence: 90%

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Selective use of transradial access for endovascular treatment of severe intracranial vertebrobasilar artery stenosis

Gao

Sun

et al. 2015

Clinical Neurology and Neurosurgery

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 90%

Selective use of transradial access for endovascular treatment of severe intracranial vertebrobasilar artery stenosis

Gao

Sun

et al. 2015

Clinical Neurology and Neurosurgery

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“…Our study also shows more than 50% of favorable outcomes on mRS (75.0% of relevant favorable outcomes on mRS) in patients with atherosclerotic BA steno-occlusion. This statistic is comparable to the study by Abuzinadah et al (16), in which the stroke recurrence rate in the symptomatic vertebrobasilar stenosis group who were treated medically was 9.6%/year and in the endovascular group was 7.2%/year. Vertebrobasilar stenosis is associated with a stroke recurrence risk that varies between 2.5-5.5% and 10-15% per year (17).…”

Section: Resultssupporting

confidence: 78%

Clinicoradiological Features and Outcomes of Patients with Atherosclerotic Basilar Artery Steno-Occlusion: A Single-Center Experience

Shin

Lee

Park

et al. 2017

J Korean Soc Radiol

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Purpose: There is a relatively higher risk of peri-procedural stroke following elective stenting of patients with basilar artery (BA) occlusion compared with stenting of intracranial arteries. We sought to diagnose stroke risks in patients with BA steno-occlusive disease by describing their clinicoradiological features and by demonstrating that appropriate treatment would lead to favorable outcomes. Materials and Methods: A total of 92 patients who were treated from 2004 to 2016 for severe stenosis or occlusion of BA based on MR or CT angiography were enrolled in the study. We assessed clinical features, radiologic findings, and other clinical outcomes such as the degree of disability as determined by the modified Rankin Scale. Results: A total of 49 of the 92 patients (53.3%) had no relevant symptoms. The risk of a recurrent or new infarct in the relevant area was 4.59%/year. Following treatment, more than 50% of the 92 patients had favorable outcomes. A recurrent or new infarct was found in 9 (20.5%) of the 44 patients who had a poor prognosis. There was no significant difference between the two groups with respect to compromised circulation; however, the initial infarct (16 of 48 and 29 of 44, p = 0.002) was statistically significant between the two groups. Conclusion: Atherosclerotic BA steno-occlusion disease is associated with a relatively low risk of a recurrent or new infarct and with favorable clinical outcomes following appropriate medical treatment. Index terms

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“…Posterior circulation strokes comprise approximately 20-25% of all strokes of ischemic origin. Strokes affecting this area carry a significantly higher risk for subsequent stroke or death as compared to anterior circulation strokes in the acute phase [7 days following initial stroke or transient ischemic attack (TIA)] [4,5]. …”

Section: Introductionmentioning

confidence: 99%

The Use of Aspiration Catheter Systems for Embolic Protection during Intracranial Vertebral Artery Angioplasty and Stenting

2015

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Background: Posterior circulation strokes comprise approximately 20-25% of all strokes of ischemic origin. Strokes affecting this area carry a significantly higher risk for subsequent stroke or death as compared to anterior circulation strokes. Embolic protection device (EPD) use for carotid artery stenosis has translated into percutaneous interventions of proximal vertebral artery (VA) stenosis. However, the use of EPDs when treating intracranial lesions has yet to be studied and may not be feasible as the vessel caliber is frequently smaller than in existing devices. Objective: The aim of this study is to describe a proximal aspiration technique used during the treatment of intracranial VA and basilar artery (BA) atherosclerotic disease. Methods: Proximal embolic protection was utilized during the treatment of intracranial VA/BA stenosis with angioplasty and stenting in patients with medically refractory disease. Results: Three patients with severe symptomatic posterior circulation stenosis refractory to medical management were treated with angioplasty and stenting utilizing proximal aspiration. Pre- and post-treatment angiograms and MRIs were compared. Treated vascular stenoses were significantly improved, without new neurological deficits or ischemic injury identified on imaging. Conclusions: The proposed technique of proximal embolic protection may help overcome the challenge of embolus propagation inherent to the treatment modality that was encountered during the treatment of intracranial VA/BA stenosis.

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Stroke recurrence rates among patients with symptomatic intracranial vertebrobasilar stenoses: systematic review and meta-analysis

Abstract: Our results showed that the risk of stroke recurrence or death or the risk of stroke recurrence alone was comparable between the medical and endovascular therapy groups. A small preventive effect of endovascular therapy may exist, particularly if the 30 day postprocedural risk is reduced.

Cited by 38 publications

References 34 publications

Selective use of transradial access for endovascular treatment of severe intracranial vertebrobasilar artery stenosis

Selective use of transradial access for endovascular treatment of severe intracranial vertebrobasilar artery stenosis

Clinicoradiological Features and Outcomes of Patients with Atherosclerotic Basilar Artery Steno-Occlusion: A Single-Center Experience

The Use of Aspiration Catheter Systems for Embolic Protection during Intracranial Vertebral Artery Angioplasty and Stenting

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