Long-term outcome of symptomatic severe ostial vertebral artery stenosis (OVAS)

Neuroradiology. 2010 May;52(5):371-9. doi: 10.1007/s00234-010-0662-0. Epub 2010 Feb 11.


Introduction: The optimal management of patients with symptomatic severe ostial vertebral artery stenosis (OVAS) is currently unclear. We analyzed the long-term outcome of consecutive patients with OVAS who received either medical treatment (MT) or vertebral artery stenting (VAS).

Methods: Thirty-nine (>70%) patients with severe OVAS were followed for a mean period of 2.8 years. The decision for VAS (n = 10) or MT (n = 29) was left to the clinician. The Kaplan-Meier method was used to assess the risk of recurrent stroke, transient ischemic attack (TIA), or death over the study period.

Results: Patients in the VAS group were significantly younger and more likely to have bilateral VA disease (P = 0.04 and P = 0.02). VAS was successfully performed in all ten patients. The periprocedural risk within 30 days was 10% (one TIA). The overall restenosis rate was 10%. One restenosis occurred after 9 months in a patient treated with bare-metal stent. At 4 years of follow-up, VAS showed a nonsignificant trend toward a lower risk for the combined endpoint of TIA and stroke in posterior circulation compared to medical treatment (10% vs. 45%, P = 0.095; relative risk (RR) = 0.24, 95% confidence interval (CI) 0.031-1.85). Patients with bilateral VA disease had a significantly lower recurrence risk after VAS compared with medical treatment (0% vs. 91% at 4 years, P = 0.004; RR 0.10, 95% CI 0.022-0.49)

Conclusion: VAS was performed without permanent complications in this small series of patients with symptomatic severe OVAS. The long-term benefit seems to be confined to patients with bilateral but not to those with unilateral VA disease.

MeSH terms

  • Age Factors
  • Aged
  • Angiography, Digital Subtraction
  • Brain / drug effects
  • Brain / pathology
  • Cerebral Angiography
  • Female
  • Follow-Up Studies
  • Humans
  • Ischemic Attack, Transient / epidemiology
  • Ischemic Attack, Transient / etiology
  • Kaplan-Meier Estimate
  • Male
  • Recurrence
  • Risk
  • Severity of Illness Index
  • Stents* / adverse effects
  • Stroke / epidemiology
  • Stroke / etiology
  • Time Factors
  • Treatment Outcome
  • Vertebrobasilar Insufficiency / drug therapy*
  • Vertebrobasilar Insufficiency / epidemiology
  • Vertebrobasilar Insufficiency / therapy*