Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS): prevalence and outcome

Abstract

We assessed the prevalence of vertebral artery (VA) stenosis or occlusion and its influence on outcome in patients with acute basilar artery occlusion (BAO). We studied 141 patients with acute BAO enrolled in the Basilar Artery International Cooperation Study (BASICS) registry of whom baseline CT angiography (CTA) of the intracranial VAs was available. In 72 patients an additional CTA of the extracranial VAs was available. Adjusted risk ratios (aRRs) for death and poor outcome, defined as a modified Rankin Scale score ≥4, were calculated with Poisson regression in relation to VA occlusion, VA occlusion or stenosis ≥50 %, and bilateral VA occlusion. Sixty-six of 141 (47 %) patients had uni- or bilateral intracranial VA occlusion or stenosis ≥50 %. Of the 72 patients with intra- and extracranial CTA, 46 (64 %) had uni- or bilateral VA occlusion or stenosis ≥50 % and 9 (12 %) had bilateral VA occlusion. Overall, VA occlusion or stenosis ≥50 % was not associated with the risk of poor outcome. Patients with intra- and extracranial CTA and bilateral VA occlusion had a higher risk of poor outcome than patients without bilateral VA occlusion (aRR, 1.23; 95 % CI 1.02-1.50). The risk of death did not depend on the presence of unilateral or bilateral VA occlusion or stenosis ≥50 %. In conclusion, in patients with acute BAO, unilateral VA occlusion or stenosis ≥50 % is frequent, but not associated with an increased risk of poor outcome or death. Patients with BAO and bilateral VA occlusion have a slightly increased risk of poor outcome.

Endovascular treatment of patients with high-risk symptomatic intracranial vertebrobasilar stenoses: long - term outcomes

“…In comparison, the long-term stroke recurrence after carotid stenting is around 7% 13. Overall treatment numbers for intracranial posterior circulation stenosis were low in all trials: VAST 9 (of 57) patients,9 VIST 13 (of 61) patients10 and SAMMPRIS 36 patients 6…”

“…One patient died of stroke in another territory and five patients succumbed to other causes. In comparison, the VAST and VIST trials reported stroke recurrence rates of 12% and 8.2% during follow-up of 3 and 3.5 years, respectively 9 10. However, in both trials intracranial and extracranial vertebrobasilar stenoses were pooled.…”

“…Randomised trials to date do not justify endovascular treatment but support the use of best medical management (BMT) alone 6–8. However, all previous trials pooled patients with intracranial and extracranial vertebrobasilar stenoses,9 10 although the underlying risks for these groups differ significantly 2 5 8. While the procedural risk for intracranial posterior circulation stenoses is higher than for extracranial lesions, so is the 90-day risk of recurrent stroke on medical treatment alone (33% intracranial vs 16% extracranial) 2…”

“…Previous trials reported few patients with intracranial posterior circulation stenoses,9 10 and long-term outcome data are scarce. There is a particular lack of outcome data for patients suspected to have the highest stroke risk on BMT (ie, recurrent ischaemic events, occluded contralateral vertebral artery and poor collateralisation).…”

Vertebral artery stenosis with subcortical ischemic infarcts and cortical atrophy without dementia presenting with TIA – case-report of a causality challenge

“…[5][6][7][8][9][10][11] Most are descriptions of symptomatic stenosis with vertebro-basilar posterior cranial fossa manifestations. [5][6][7] 20% of strokes are caused by vertebral artery stenosis. 8 The prevalence of vertebral artery stenosis without vertebro-basilar symptoms, as in this case, is poorly quantified, though studies put it at approximately 8%.…”