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Stroke-free survival and its determinants in patients with symptomatic vertebrobasilar stenosis: a multicenter study
Adnan I Qureshi1, Wendy C Ziai, Abutaher M Yahia
1Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07103, USA. aiqureshi@hotmail.com
Insights
Patients with symptomatic vertebrobasilar stenosis have a low rate of long-term stroke-free survival. Treatment with antiplatelet agents or warfarin showed a protective effect, highlighting the need for improved therapeutic strategies.
Area of Science:
- Neurology
- Vascular Neurology
- Medical Imaging
Background:
- Intracranial vertebrobasilar stenosis is a significant cause of ischemic events.
- Understanding long-term outcomes is crucial for managing patients with this condition.
Purpose of the Study:
- To determine the long-term stroke-free survival in patients presenting with ischemic events due to intracranial vertebrobasilar stenosis.
- To identify factors influencing stroke-free survival in this patient cohort.
Main Methods:
- Retrospective cohort study of 102 patients diagnosed with symptomatic vertebrobasilar stenosis.
- Diagnosis confirmed via magnetic resonance angiography and/or conventional angiography.
- Kaplan-Meier and Cox proportional hazards analyses were used to assess stroke-free survival and influencing factors.
Main Results:
- Overall 5-year stroke-free survival was 48%.
- Recurrent stroke occurred in 14% of patients during the follow-up period.
- Increasing age was associated with decreased stroke-free survival, while antiplatelet agents or warfarin demonstrated a protective effect.
Conclusions:
- Patients with symptomatic vertebrobasilar stenosis exhibit a concerningly low rate of long-term stroke-free survival.
- Further research into novel medical and endovascular treatments is warranted to enhance outcomes for this patient group.
Objective:
We sought to determine the long-term stroke-free survival of patients who present with ischemic events related to intracranial vertebrobasilar stenosis.
Methods:
A retrospective cohort of patients diagnosed with symptomatic vertebrobasilar stenosis on the basis of magnetic resonance angiography and/or conventional angiography was identified at four academic medical centers. Patients' clinical and follow-up information was obtained through hospitalization records, clinic visits, and telephone interviews. Kaplan-Meier analysis was performed to determine the rate of stroke-free survival for a 5-year period. Cox proportional hazards analysis was performed to determine the effect of demographic and clinical factors on stroke-free survival.
Results:
A total of 102 patients were included, whose mean age was 64 +/- 12 years. Fifty-five (54%) of the patients were men. The mean follow-up period was 15 +/- 15.9 months (range, 1-60 mo). During the follow-up period, 14 (14%) of the patients experienced recurrent stroke. The overall mortality rate was 21% (n = 21). Stroke-free survival, calculated by using the Kaplan-Meier curve, was 76% at 12 months (95% confidence interval [CI], 66-83%) and 48% at 5 years (95% CI, 27-65%). The risk of recurrent stroke was 10.9 per 100 patient-years, and the rate of recurrent stroke and/or death was 24.2 per 100 patient-years. Cox proportional hazards analysis revealed that increasing age (hazards ratio, 1.05; 95% CI, 1.00-1.09) decreased stroke-free survival. Treatment with either antiplatelet agents or warfarin (hazards ratio, 0.018; 95% CI, 0.003-0.11) had a protective effect on stroke-free survival after adjusting for age, sex, race, hypertension, diabetes mellitus, smoking, hyperlipidemia, and lesion location.
Conclusion:
A low rate of stroke-free survival is observed in patients with symptomatic vertebrobasilar stenosis. Further studies are required to evaluate new medical and endovascular treatment options for this group of patients to improve long-term stroke-free survival.